Original Investigation
Pathogenesis and Treatment of Kidney Disease
Obesity and Change in Estimated GFR Among Older Adults

https://doi.org/10.1053/j.ajkd.2009.07.018Get rights and content

Background

The prevalence of chronic kidney disease is growing most rapidly among older adults; however, determinants of impaired kidney function in this population are not well understood. Obesity assessed in midlife has been associated with chronic kidney disease.

Study Design

Cohort study.

Setting & Participants

4,295 participants in the community-based Cardiovascular Health Study, aged ≥ 65 years.

Predictors

Body mass index, waist circumference, and fat mass measured using bioelectrical impedance.

Outcome

Change in glomerular filtration rate (GFR) during 7 years of follow-up.

Measurements

Longitudinal estimates of GFR calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation.

Results

Estimated GFR decreased by an average of 0.4 ± 3.6 mL/min/1.73 m2/y, and rapid GFR loss (>3 mL/min/1.73 m2/y) occurred in 693 participants (16%). Baseline body mass index, waist circumference, and fat mass were each associated with increased risk of rapid GFR loss: ORs, 1.19 (95% CI, 1.09-1.30) per 5 kg/m2, 1.25 (95% CI, 1.16-1.36) per 12 cm, and 1.14 (95% CI, 1.05-1.24) per 10 kg after adjustment for age, sex, race, and smoking. The magnitude of increased risk was larger for participants with estimated GFR < 60 mL/min/1.73 m2 at baseline (P for interaction < 0.05). Associations were substantially attenuated by further adjustment for diabetes, hypertension, and C-reactive protein level. Obesity measurements were not associated with change in GFR estimated using serum cystatin C level.

Limitations

Few participants with advanced chronic kidney disease at baseline, no direct GFR measurements.

Conclusion

Obesity may be a modifiable risk factor for the development and progression of kidney disease in older adults.

Section snippets

Study Population

The CHS is a cohort study of risk factors for the development and progression of cardiovascular disease in people ≥ 65 years. A total of 5,888 participants were recruited from 4 communities in the United States: Forsyth County, NC; Sacramento County, CA; Washington County, MD; and Pittsburgh, PA. Eligible participants, sampled from Medicare eligibility lists, were not institutionalized and were expected to remain in the area for at least 3 years. Persons who were wheelchair bound in the home or

Baseline Characteristics

CHS participants excluded from the present analyses because they had < 2 estimated GFR measurements were older (mean age, 75 vs 72 years) and more likely to be men (48% vs 41%), be African American (23% vs 13%), and have diabetes (24% vs 14%). However, there were no substantial differences in BMI (26.7 vs 26.7 kg/m2), waist circumference (96 vs 94 cm), fat mass (41 vs 40 kg), or fat-free mass (33 vs 33 kg).

At baseline, in participants included in the present analyses, mean age was 72 years, 59%

Discussion

Obesity was associated with a decrease in GFR estimated using the MDRD Study equation during 7 years of follow-up in a large community-based population of older adults. Results were consistent within each sex and were observed whether obesity was measured as BMI, waist circumference, or fat mass using bioelectrical impedance. Associations of obesity with GFR loss were stronger in participants with impaired GFR at baseline and were substantially attenuated by adjustment for diabetes,

Acknowledgements

A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm. Data contained in this manuscript were presented in part at the American Society of Nephrology Renal Week, November 4-9, 2008, Philadelphia, PA.

Support: The research reported in this article was supported by contract numbers N01-HC-85079 to N01-HC-85086, N01-HC-35129, N01-HC-15103, N01-HC-55222, N01-HC-75150, N01-HC-45133, and grant number U01 HL080295 from the National Heart, Lung, and

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    Originally published online as doi:10.1053/j.ajkd.2009.07.018 on September 27, 2009.

    Because the Editor-in-Chief and Deputy Editor recused themselves from consideration of this manuscript, the peer-review and decision-making processes were handled entirely by a Co-Editor (Bertrand L. Jaber, MD, MS, Caritas St. Elizabeth's Medical Center) who served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

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