title: Body mass index and early kidney function decline in young adults: a longitudinal analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) study.
abstract: BACKGROUND
  Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline.
  
  
  METHODS
  Longitudinal cohort.
  
  
  METHODS
  2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
  
  
  METHODS
  BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2).
  
  
  RESULTS
  Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys <60mL/min/1.73m(2) over 10 years of follow-up.
  
  
  METHODS
  GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20.
  
  
  RESULTS
  At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). In unadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant.
  
  
  CONCLUSIONS
  Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level.
  
  
  CONCLUSIONS
  Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.
authors.affiliation: University of California, San Francisco, CA. Electronic address: grubbsv@medsfgh.ucsf.edu.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D015331:Cohort Studies; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors; D055815:Young Adult
chemical_list: D055316:Cystatin C
keywords: Kidney function decline; obesity; risk factor