Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study.
BACKGROUND
Prior research yielded conflicting results about the magnitude of the association between body mass index (BMI) and chronic kidney disease (CKD).


METHODS
Prospective cohort study.


METHODS
Framingham Offspring participants (n = 2,676; 52% women; mean age, 43 years) free of stage 3 CKD at baseline who participated in examination cycles 2 (1978-1981) and 7 (1998-2001).


METHODS
BMI.


RESULTS
Stage 3 CKD (estimated glomerular filtration rate < 59 mL/min/1.73 m(2) for women and < 64 mL/min/1.73 m(2) for men).


METHODS
Age-, sex-, and multivariable-adjusted (diabetes, systolic blood pressure, hypertension treatment, current smoking status, and high-density lipoprotein cholesterol level) logistic regression models were used to examine the relationship between BMI at baseline and incident stage 3 CKD and incident dipstick proteinuria (trace or greater).


RESULTS
At baseline, 36% of the sample was overweight and 12% was obese; 7.9% (n = 212) developed stage 3 CKD during 18.5 years of follow-up. Relative to participants with normal BMI, there was no association between overweight individuals and stage 3 CKD incidence in age- and sex-adjusted models (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.93 to 1.81; P = 0.1) or multivariable models (OR, 1.06; 95% CI, 0.75 to 1.50; P = 0.8). Obese individuals had a 68% increased odds of developing stage 3 CKD (OR, 1.68; 95% CI, 1.10 to 2.57; P = 0.02), which became nonsignificant in multivariable models (OR, 1.09; 95% CI, 0.69 to 1.73; P = 0.7). Similar findings were observed when BMI was modeled as a continuous variable or quartiles. Incident proteinuria occurred in 14.4%; overweight and obese individuals were at increased odds of proteinuria in multivariable models (OR, 1.43; 95% CI, 1.09 to 1.88; OR, 1.56; 95% CI, 1.08 to 2.26, respectively).


CONCLUSIONS
BMI is measure of generalized obesity and not abdominal obesity. Participants are predominantly white, and these findings may not apply to different ethnic groups.


CONCLUSIONS
Obesity is associated with increased risk of developing stage 3 CKD, which was no longer significant after adjustment for known cardiovascular disease risk factors. The relationship between obesity and stage 3 CKD may be mediated through cardiovascular disease risk factors.
Foster
Meredith C
MC
Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA, USA.
Hwang
Shih-Jen
SJ
Larson
Martin G
MG
Lichtman
Judith H
JH
Parikh
Nisha I
NI
Vasan
Ramachandran S
RS
Levy
Daniel
D
Fox
Caroline S
CS
D000328:Adult; D017677:Age Distribution; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D003404:Creatinine