title: Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.
abstract: BACKGROUND
  The association between waist circumference and end-stage renal disease (ESRD) remains poorly explored.
  
  
  METHODS
  Longitudinal population-based cohort.
  
  
  METHODS
  Participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study (n=30,239) with information for body mass index (BMI), waist circumference, spot urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR; n=26,960).
  
  
  METHODS
  Elevated waist circumference or BMI.
  
  
  METHODS
  Incident cases of ESRD were identified through linkage of REGARDS participants with the US Renal Data System.
  
  
  RESULTS
  Mean baseline age was 64.8 years, 45.8% were men, and 40.3% were black. Overall, 297 (1.1%) individuals developed ESRD during a median of 6.3 years. After adjustment for all covariates including waist circumference, no significant association was noted between BMI categories and ESRD incidence compared to BMI of 18.5 to 24.9 kg/m2 (referent). Higher waist circumference categories showed significantly increased hazard rates of ESRD, with waist circumference ≥ 108 cm in women and ≥122 cm in men (highest category) showing a 3.97-fold higher hazard rate (95% CI, 2.10-6.86) for ESRD compared to waist circumference < 80 cm in women and <94 cm in men (referent) after adjusting for demographic factors and BMI. However, no significant association was noted between any waist circumference category and ESRD incidence after adjustment for obesity-associated comorbid conditions and baseline ACR and eGFR.
  
  
  CONCLUSIONS
  Short follow-up period (6.3 years) to assess ESRD risk among adults with eGFRs>60 mL/min/1.73 m2.
  
  
  CONCLUSIONS
  In this cohort of older adults, obesity as measured by waist circumference is associated with higher ESRD risk even with adjustment for BMI, whereas obesity as measured by BMI is not associated with higher ESRD risk after adjustment for waist circumference. However, no significant association is noted between increased waist circumference and ESRD risk after adjustment for obesity-related comorbid conditions, eGFR, and ACR.
authors.affiliation: Department of Public Health Sciences, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL; Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL. Electronic address: hkramer@luc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutiérrez
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Panwar
authors.affiliation: Department of Public Health Sciences, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL.
authors.forename: David A
authors.initials: DA
authors.lastname: Shoham
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA; Department of Epidemiology, Emory University, Atlanta, GA.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D044469:Racial Groups; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D055105:Waist Circumference
keywords: Adiposity; US Renal Data System (USRDS); body mass index (BMI); chronic kidney disease (CKD); chronic renal failure; dialysis; end-stage renal disease (ESRD); obesity; renal failure; waist circumference