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D. E. Rifkin, M. G. Shlipak, R. Katz, L. F. Fried, D. Siscovick, M. Chonchol, A. B. Newman and M. J. Sarnak, “Rapid Kidney Function Decline and Mortality Risk in Older Adults,” Archives of Internal Medicine, Vol. 168, No. 20, 2008, pp. 2212-2218. doi:10.1001/archinte.168.20.2212

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• TITLE: Association of Obesity and Kidney Function Decline among Non-Diabetic Adults with eGFR > 60 ml/min/1.73m2: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

  AUTHORS: Anna Malkina, Ronit Katz, Michael G. Shlipak, Joachim H. Ix, Ian H. de Boer, Mark J. Sarnak, Matthew Allison, Holly J. Kramer, Julie Lin, David Siscovick, Carmen A. Peralta

  KEYWORDS: Kidney Function Decline; MESA; Obesity; Waist Circumference; Waist-to-Hip Ratio

  JOURNAL NAME: Open Journal of Endocrine and Metabolic Diseases, Vol.3 No.2, May 23, 2013

  ABSTRACT: Background: Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized. Methods: We studied the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with rapid kidney function decline and incident chronic kidney disease in 4573 non-diabetic adults with eGFR ≥ 60 ml/min/1.73m2 at baseline from longitudinal Multi-Ethnic Study of Atherosclerosis cohort. Kidney function was estimated by creatinine and cystatin C. Multivariate analysis was adjusted for age, race, baseline eGFR, and hypertension. Results: Mean age was 60 years old, BMI 28 kg/m2, baseline eGFRCr 82 and eGFRCys 95 ml/min/1.73m2. Over 5 years of follow up, 25% experienced rapid decline in renal function by eGFRCr and 22% by eGFRCys. Incident chronic kidney disease (CKD) developed in 3.3% by eGFRCys, 11% by eGFRCr, and 2.4% by both makers. Compared to persons with BMI 25, overweight (BMI 25 - 30) persons had thelowest risk of rapid decline by eGFRCr (0.84, 0.71 - 0.99). In contrast, higher BMI categories were associated with stepwise higher odds of rapid decline by eGFRCys, but remained significant only when BMI ≥ 35 kg/m2 (1.87, 1.41 - 2.48). Associations of BMI with incident CKD were insignificant after adjustment. Large WC and WHR were associated with increased risk of rapid decline only by eGFRCys, and of incident CKD only when defined by both filtration markers. Conclusions: Obesity may be a risk factor for kidney function decline, but associations vary by filtration marker used.