title: Association of Obesity and Kidney Function Decline among Non-Diabetic Adults with eGFR > 60 ml/min/1.73m2: Results from the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized.
  
  
  METHODS
  We studied the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with rapid kidney function decline and incident chronic kidney disease in 4573 non-diabetic adults with eGFR ≥ 60 ml/min/1.73m2at baseline from longitudinal Multi-Ethnic Study of Atherosclerosis cohort. Kidney function was estimated by creatinine and cystatin C. Multivariate analysis was adjusted for age, race, baseline eGFR, and hypertension.
  
  
  RESULTS
  Mean age was 60 years old, BMI 28 kg/m2, baseline eGFRCr82 and eGFRCys95 ml/min/1.73m2. Over 5 years of follow up, 25% experienced rapid decline in renal function by eGFRCrand 22% by eGFRCys. Incident chronic kidney disease (CKD) developed in 3.3% by eGFRCys, 11% by eGFRCr, and 2.4% by both makers. Compared to persons with BMI < 25, overweight (BMI 25 - 30) persons had the lowest risk of rapid decline by eGFRCr(0.84, 0.71 - 0.99). In contrast, higher BMI categories were associated with stepwise higher odds of rapid decline by eGFRCys, but remained significant only when BMI ≥ 35 kg/m2(1.87, 1.41 - 2.48). Associations of BMI with incident CKD were insignificant after adjustment. Large WC and WHR were associated with increased risk of rapid decline only by eGFRCys, and of incident CKD only when defined by both filtration markers.
  
  
  CONCLUSIONS
  Obesity may be a risk factor for kidney function decline, but associations vary by filtration marker used.
authors.affiliation: University of California, San Francisco, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Malkina
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: University of California, San Francisco, USA ; San Francisco Veterans Affairs Medical Center, San Francisco, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: University of California, San Diego, USA.
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Tufts Medical Center, Boston, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: University of California, San Diego, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.affiliation: Loyola University Medical Center, Maywood, USA.
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Kramer
authors.affiliation: Harvard University, Cambridge, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Lin
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.affiliation: University of California, San Francisco, USA ; San Francisco Veterans Affairs Medical Center, San Francisco, USA.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
keywords: Kidney Function Decline; MESA; Obesity; Waist Circumference; Waist-to-Hip Ratio