title: Obesity, metabolic health, and the risk of end-stage renal disease.
abstract: Obesity is associated with chronic kidney disease progression. Whether metabolic risk factors modify this association is unclear. Here we examined associations of body mass index (BMI) and metabolic health with risk of end-stage renal disease (ESRD) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Among 21,840 participants eligible for analysis, 247 developed ESRD (mean follow-up of 6.3 years). Metabolic health significantly modified the association of BMI with ESRD. In models stratified by the presence or absence of the metabolic syndrome and adjusted for demographic, lifestyle, and clinical factors, higher BMI was associated with lower risk of ESRD in those without (hazard ratio per 5 kg/m2 increase in BMI 0.70, 95% CI 0.52, 0.95) but not those with (hazard ratio, 1.06) the metabolic syndrome. In models stratified by weight and metabolic health, compared with normal weight (BMI 18.5-24.9 kg/m2) participants without the metabolic syndrome the overweight individuals (BMI 25-29.9) and obese individuals (BMI of 30 or more) with the metabolic syndrome had greater risk of ESRD (hazard ratios of 2.03 and 2.29, respectively), whereas obesity without the metabolic syndrome was associated with lower risk of ESRD (hazard ratio 0.47). Thus, higher BMI is associated with lower ESRD risk in those without but not those with the metabolic syndrome.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Panwar
authors.affiliation: 1] Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA [2] Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Lynae J
authors.initials: LJ
authors.lastname: Hanks
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: 1] Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA [2] Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Preventive Medicine, Loyola University, Maywood, Illinois, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Departments of Epidemiology and Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: 1] Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA [2] Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology