title: Adiposity patterns and the risk for ESRD in postmenopausal women.
abstract: OBJECTIVE
  Body mass index and waist circumference associate with adverse health outcomes, including CKD. Studies of the association of body mass index and ESRD have been inconsistent; these adiposity measures have not been previously assessed together for ESRD risk or among postmenopausal women.
  
  
  METHODS
  This was prospective cohort study of 20,117 postmenopausal women enrolled in the multiethnic cohort of the Women's Health Initiative. Body mass index and waist circumference were obtained at baseline, incident ESRD was obtained from the US Renal Data System, and all-cause death was obtained from surveillance data. A competing-risk framework was used to account for the effect of mortality before ESRD while adjusting for significant predictors and baseline kidney function. Associations of adiposity with mortality were also studied.
  
  
  RESULTS
  Events included 212 patients with incident ESRD and 3104 deaths for a mean follow-up of 11.6 years. Increased waist circumference and body mass index were associated with 2.59- (95% confidence interval, 1.89 to 3.53) and 1.97-fold (95% confidence interval, 1.30 to 2.98) higher hazards of ESRD as well as 1.42- (95% confidence interval, 1.32 to 1.53) and 1.21-fold (95% confidence interval, 1.11 to 1.33) higher hazards of death, respectively, compared with the lower categories in adjusted analyses. The associations of waist circumference with ESRD varied by baseline renal function (P for interaction=0.01) and were significant only among women without baseline eGFR-defined CKD (hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.03).
  
  
  CONCLUSIONS
  Central obesity was associated with an increased risk of ESRD in postmenopausal women, even among women with normal body mass index but not among women with reduced baseline kidney function, and an increased risk of death. Body mass index was associated with ESRD, and the association is likely mediated through hypertension and diabetes.
authors.affiliation: Departments of Epidemiology and noraf@unc.edu.
authors.forename: Nora
authors.initials: N
authors.lastname: Franceschini
authors.affiliation: Biostatistics, University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Gouskova
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington;
authors.forename: Alex P
authors.initials: AP
authors.lastname: Reiner
authors.affiliation: Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island;
authors.forename: Andrew
authors.initials: A
authors.lastname: Bostom
authors.affiliation: MedStar Health Research Institute, Hyattsville, Maryland; Center for Clinical and Translational Sciences and Department of Medicine, Georgetown-Howard Universities, Washington, DC;
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; and.
authors.forename: Mary
authors.initials: M
authors.lastname: Pettinger
authors.affiliation: MedStar Health Research Institute, Hyattsville, Maryland; Center for Clinical and Translational Sciences and Department of Medicine, Georgetown-Howard Universities, Washington, DC;
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.affiliation: Departments of Epidemiology and.
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.affiliation: Section of Nephrology, Baylor College of Medicine, Houston, Texas.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Department of Family Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, Rhode Island;
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.affiliation: Departments of Epidemiology and.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.affiliation: Biostatistics, University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Jason P
authors.initials: JP
authors.lastname: Fine
mesh_terms: D050154:Adiposity; D001741:Black or African American; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D044465:White People
keywords: ESRD; chronic renal failure; clinical epidemiology; epidemiology and outcomes; risk factors