Waist-to-hip ratio, body mass index, and subsequent kidney disease and death.
BACKGROUND
Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality.


METHODS
Cohort study.


METHODS
Individual patient data pooled from the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study.


METHODS
Waist-to-hip ratio (WHR), body mass index (BMI).


METHODS
Incident CKD defined as serum creatinine level increase greater than 0.4 mg/dL with baseline creatinine level of 1.4 mg/dL or less in men and 1.2 mg/dL or less in women and final creatinine level greater than these levels, and, in separate analyses, estimated glomerular filtration rate (eGFR) decrease of 15 mL/min/1.73 m(2) or greater with baseline eGFR of 60 mL/min/1.73 m(2) or greater and final eGFR less than 60 mL/min/1.73 m(2). Multivariable logistic regression to determine the association between WHR, BMI, and outcomes. Cox models to evaluate a secondary composite outcome of all-cause mortality and incident CKD.


RESULTS
Of 13,324 individuals, mean WHR was 0.96 in men and 0.89 in women and mean BMI was 27.2 kg/m(2) in both men and women. During 9.3 years, 300 patients (2.3%) in creatinine-based models and 710 patients (5.5%) in eGFR-based models developed CKD. In creatinine-based models, each SD increase in WHR was associated with increased risk of incident CKD (odds ratio, 1.22; 95% confidence interval [CI], 1.05 to 1.43) and the composite outcome (hazard ratio, 1.12; 95% CI, 1.06 to 1.18), whereas each SD increase in BMI was not associated with CKD (odds ratio, 1.05; 95% CI, 0.93 to 1.20) and appeared protective for the composite outcome (hazard ratio, 0.94; 95% CI, 0.90 to 0.99). Results of eGFR-based models were similar.


CONCLUSIONS
Single measures of creatinine, no albuminuria data.


CONCLUSIONS
WHR, but not BMI, is associated with incident CKD and mortality. Assessment of CKD risk should use WHR rather than BMI as an anthropomorphic measure of obesity.
Nephrology Research Center, Tufts-New England Medical Center, Boston, MA 02111, USA.
Essam F
EF
Elsayed
Mark J
MJ
Sarnak
Hocine
H
Tighiouart
John L
JL
Griffith
Tobias
T
Kurth
Deeb N
DN
Salem
Andrew S
AS
Levey
Daniel E
DE
Weiner
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D049629:Waist-Hip Ratio
D003404:Creatinine