Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program.
BACKGROUND
Obesity is associated with increased single-nephron glomerular filtration rate, which may increase the risk for chronic kidney disease (CKD), especially when combined with hypertension. However, epidemiological data supporting an association between overweight and obesity and risk for CKD currently are limited.


METHODS
We used data from the Hypertension Detection and Follow-Up Program (HDFP) to test the hypothesis that overweight and obesity are associated with incident CKD in 5,897 hypertensive adults. Serum and spot urine samples were collected at baseline and year 5. CKD is defined as the presence of 1+ or greater proteinuria on routine urinalysis and/or an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 (<1.0 mL/s).


RESULTS
In HDFP participants without CKD at baseline, the incidence of CKD at year 5 was 28% in the ideal-body-mass-index group, 31% in the overweight group, and 34% in the obese group. After adjustment for all covariates, including diabetes mellitus, mean baseline diastolic blood pressure, and slope of diastolic blood pressure, both baseline overweight (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05 to 1.41) and obesity (OR, 1.40; 95% CI, 1.20 to 1.63) were associated with increased odds of incident CKD at year 5. Similar results were noted after exclusion of participants with baseline diabetes mellitus, with both overweight (OR, 1.22; 95% CI, 1.05 to 1.43) and obesity (OR, 1.38; 95% CI, 1.17 to 1.63) remaining significantly associated with incident CKD.


CONCLUSIONS
These results suggest that obese adults with hypertension have an increased risk for CKD.
Kramer
Holly
H
Department of Preventive Medicine, Loyola Medical Center, Maywood, IL 60153, USA. hkramer@lumc.edu
Luke
Amy
A
Bidani
Anil
A
Cao
Guichan
G
Cooper
Richard
R
McGee
Dan
D
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data