Cargando…

Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England

BACKGROUND: It is uncertain whether being overweight, but not obese, is associated with advanced chronic kidney disease (CKD) and how the size and shape of associations between body-mass index (BMI) and advanced CKD differs among different types of people. METHODS: We used Clinical Practice Research...

Descripción completa

Detalles Bibliográficos
Autores principales: Herrington, William G., Smith, Margaret, Bankhead, Clare, Matsushita, Kunihiro, Stevens, Sarah, Holt, Tim, Hobbs, F. D. Richard, Coresh, Josef, Woodward, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342319/
https://www.ncbi.nlm.nih.gov/pubmed/28273171
http://dx.doi.org/10.1371/journal.pone.0173515
_version_ 1782513152005505024
author Herrington, William G.
Smith, Margaret
Bankhead, Clare
Matsushita, Kunihiro
Stevens, Sarah
Holt, Tim
Hobbs, F. D. Richard
Coresh, Josef
Woodward, Mark
author_facet Herrington, William G.
Smith, Margaret
Bankhead, Clare
Matsushita, Kunihiro
Stevens, Sarah
Holt, Tim
Hobbs, F. D. Richard
Coresh, Josef
Woodward, Mark
author_sort Herrington, William G.
collection PubMed
description BACKGROUND: It is uncertain whether being overweight, but not obese, is associated with advanced chronic kidney disease (CKD) and how the size and shape of associations between body-mass index (BMI) and advanced CKD differs among different types of people. METHODS: We used Clinical Practice Research Datalink records (2000–2014) with linkage to English secondary care and mortality data to identify a prospective cohort with at least one BMI measure. Cox models adjusted for age, sex, smoking and social deprivation and subgroup analyses by diabetes, hypertension and prior cardiovascular disease assessed relationships between BMI and CKD stages 4–5 and end-stage renal disease (ESRD). FINDINGS: 1,405,016 adults aged 20–79 with mean BMI 27.4kg/m(2) (SD 5.6) were followed for 7.5 years. Compared to a BMI of 20 to <25kg/m(2), higher BMI was associated with a progressively increased risk of CKD stages 4–5 (hazard ratio 1.34, 95% CI 1.30–1.38 for BMI 25 to <30kg/m(2); 1.94, 1.87–2.01 for BMI 30 to <35kg/m(2); and 3.10, 2.95–3.25 for BMI ≥35kg/m(2)). The association between BMI and ESRD was shallower and reversed at low BMI. Current smoking, prior diabetes, hypertension or cardiovascular disease all increased risk of CKD, but the relative strength and shape of BMI-CKD associations, which were generally log-linear above a BMI of 25kg/m(2), were similar among those with and without these risk factors. There was direct evidence that being overweight was associated with increased risk of CKD stages 4–5 in these subgroups. Assuming causality, since 2000 an estimated 39% (36–42%) of advanced CKD in women and 26% (22–30%) in men aged 40–79 resulted from being overweight or obese. CONCLUSIONS: This study provides direct evidence that being overweight increases risk of advanced CKD, that being obese substantially increases such risk, and that this remains true for those with and without diabetes, hypertension or cardiovascular disease. Strategies to reduce weight among those who are overweight, as well as those who are obese may reduce CKD risk, with each unit reduction in BMI yielding similar relative reductions in risk.
format Online
Article
Text
id pubmed-5342319
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-53423192017-03-29 Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England Herrington, William G. Smith, Margaret Bankhead, Clare Matsushita, Kunihiro Stevens, Sarah Holt, Tim Hobbs, F. D. Richard Coresh, Josef Woodward, Mark PLoS One Research Article BACKGROUND: It is uncertain whether being overweight, but not obese, is associated with advanced chronic kidney disease (CKD) and how the size and shape of associations between body-mass index (BMI) and advanced CKD differs among different types of people. METHODS: We used Clinical Practice Research Datalink records (2000–2014) with linkage to English secondary care and mortality data to identify a prospective cohort with at least one BMI measure. Cox models adjusted for age, sex, smoking and social deprivation and subgroup analyses by diabetes, hypertension and prior cardiovascular disease assessed relationships between BMI and CKD stages 4–5 and end-stage renal disease (ESRD). FINDINGS: 1,405,016 adults aged 20–79 with mean BMI 27.4kg/m(2) (SD 5.6) were followed for 7.5 years. Compared to a BMI of 20 to <25kg/m(2), higher BMI was associated with a progressively increased risk of CKD stages 4–5 (hazard ratio 1.34, 95% CI 1.30–1.38 for BMI 25 to <30kg/m(2); 1.94, 1.87–2.01 for BMI 30 to <35kg/m(2); and 3.10, 2.95–3.25 for BMI ≥35kg/m(2)). The association between BMI and ESRD was shallower and reversed at low BMI. Current smoking, prior diabetes, hypertension or cardiovascular disease all increased risk of CKD, but the relative strength and shape of BMI-CKD associations, which were generally log-linear above a BMI of 25kg/m(2), were similar among those with and without these risk factors. There was direct evidence that being overweight was associated with increased risk of CKD stages 4–5 in these subgroups. Assuming causality, since 2000 an estimated 39% (36–42%) of advanced CKD in women and 26% (22–30%) in men aged 40–79 resulted from being overweight or obese. CONCLUSIONS: This study provides direct evidence that being overweight increases risk of advanced CKD, that being obese substantially increases such risk, and that this remains true for those with and without diabetes, hypertension or cardiovascular disease. Strategies to reduce weight among those who are overweight, as well as those who are obese may reduce CKD risk, with each unit reduction in BMI yielding similar relative reductions in risk. Public Library of Science 2017-03-08 /pmc/articles/PMC5342319/ /pubmed/28273171 http://dx.doi.org/10.1371/journal.pone.0173515 Text en © 2017 Herrington et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Herrington, William G.
Smith, Margaret
Bankhead, Clare
Matsushita, Kunihiro
Stevens, Sarah
Holt, Tim
Hobbs, F. D. Richard
Coresh, Josef
Woodward, Mark
Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title_full Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title_fullStr Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title_full_unstemmed Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title_short Body-mass index and risk of advanced chronic kidney disease: Prospective analyses from a primary care cohort of 1.4 million adults in England
title_sort body-mass index and risk of advanced chronic kidney disease: prospective analyses from a primary care cohort of 1.4 million adults in england
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342319/
https://www.ncbi.nlm.nih.gov/pubmed/28273171
http://dx.doi.org/10.1371/journal.pone.0173515
work_keys_str_mv AT herringtonwilliamg bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT smithmargaret bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT bankheadclare bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT matsushitakunihiro bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT stevenssarah bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT holttim bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT hobbsfdrichard bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT coreshjosef bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland
AT woodwardmark bodymassindexandriskofadvancedchronickidneydiseaseprospectiveanalysesfromaprimarycarecohortof14millionadultsinengland