title: Impact of BMI on cardiovascular events, renal function, and coronary artery calcification.
abstract: OBJECTIVE
  High BMI increases the risk of cardiovascular events (CVEs) in the general population. Conflicting results have been reported on the role of BMI on CVEs and on decline of renal function in patients with chronic kidney disease not on dialysis (CKD). This study evaluates the impact of BMI on CVEs, dialysis initiation, and coronary artery calcification (CAC) in CKD patients.
  
  
  METHODS
  CKD patients were divided in normal-BMI and high-BMI patients. CVEs, initiation of dialysis, and extent and progression of CAC were assessed. Univariate and multivariable analysis were performed (adjustment variables: age, diabetes, hypertension, gender, CKD stage, serum concentration of hemoglobin, parathyroid hormone, calcium, phosphorus, albumin, C-reactive protein, LDL-cholesterol, total calcium score, 24-hour proteinuria). Patients were followed to the first event (CVE, dialysis) or for 2 years.
  
  
  RESULTS
  471 patients were evaluated. A CVE occurred in 13.5 and 21.3% (p < 0.05) of normal-BMI and high-BMI patients, respectively. High BMI did not increase the risk for CVEs in univariate (HR: 1.86; 95% CI: 0.97-3.54; p = 0.06) or multivariable analysis (HR: 1.36; 95% CI: 0.57-3.14; p = 0.50). High BMI did not increase the risk for initiation of dialysis in univariate (HR: 0.96; 95% CI: 0.58-1.60; p = 0.9) or multivariable analysis (HR: 1.77; 95% CI: 0.82-3.81; p = 0.14). Adding the interaction term (between BMI and glomerular filtration rate) to other variables, the risk of dialysis initiation significantly increased (HR: 3.06; 95% CI: 1.31-7.18; p = 0.01) in high-BMI patients. High BMI was not a predictor of CAC extent or progression.
  
  
  CONCLUSIONS
  High BMI was not a predictor of CVEs. High BMI increased the risk for dialysis initiation, but high BMI was not associated to CAC extent and progression. The presence of confounders may underestimate the impact of high BMI on dialysis initiation.
authors.affiliation: Department of Nephrology, University of Naples 'Federico II', Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.forename: Luigi Francesco
authors.initials: LF
authors.lastname: Morrone
authors.forename: Carmela
authors.initials: C
authors.lastname: Errichiello
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: De Gregorio
authors.forename: Massimo
authors.initials: M
authors.lastname: Imbriaco
authors.forename: Yuri
authors.initials: Y
authors.lastname: Battaglia
authors.forename: Luigi
authors.initials: L
authors.lastname: Russo
authors.forename: Michele
authors.initials: M
authors.lastname: Andreucci
authors.forename: Biagio Raffaele
authors.initials: BR
authors.lastname: Di Iorio
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D003331:Coronary Vessels / Q000378:metabolism / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011507:Proteinuria / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D061205:Vascular Calcification / Q000097:blood / Q000150:complications / Q000503:physiopathology*
chemical_list: D008078:Cholesterol, LDL; D006454:Hemoglobins; D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; D002097:C-Reactive Protein; D002118:Calcium