title: Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012.
abstract: Prevalence and factors associated with obstructive and restrictive lung function in people with chronic kidney disease (CKD) are unknown.
  
  
  
  Cross-sectional and longitudinal analyses.
  
  
  
  Participants aged 40 to 79 years from NHANES (National Health and Nutrition Examination Survey) 2007 to 2012 who underwent spirometry testing.
  
  
  
  CKD (estimated glomerular filtration rate [eGFR] >15-<60mL/min/1.73m(2) or urinary albumin-creatinine ratio ≥ 30mg/g).
  
  
  
  Restrictive lung function (defined as FEV1/FVC≥0.70 and baseline FVC<80% predicted), obstructive lung function (defined as FEV1/FVC<0.70 based on postbronchodilator spirometric results), and mortality data (available for 2007-2008 and 2009-2010 survey periods).
  
  
  
  7,610 participants (CKD=1,338; non-CKD=6,272) were included. Prevalences of obstructive lung function adjusted to the mean age of 55 years and 50% men in the CKD and non-CKD groups were 15.6% and 13.3%, respectively (P=0.2). Similarly, adjusted prevalences of restrictive lung function in the CKD and non-CKD groups were 9.8% and 6.7%, respectively (P=0.01). Presence of albumin-creatinine ratio ≥ 30mg/g was associated with obstructive (OR, 1.42; 95% CI, 1.07-1.88) and restrictive lung function (OR, 1.43; 95% CI, 1.01-2.03) in the entire study cohort. eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. In a multivariable Cox model, age (HR, 1.07; 95% CI, 1.04-1.11) and presence of obstructive lung function (HR, 2.68; 95% CI, 1.80-3.97), but not CKD measures, were associated with death.
  
  
  
  Small proportion of participants with advanced kidney disease.
  
  
  
  In a representative sample of US adults, impaired lung function is common in those with and without CKD. Albuminuria was independently associated with both obstructive and restrictive lung function, and eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. Older age and obstructive lung function were associated with higher likelihood of death. Further studies examining the burden of lung disease in advanced CKD are needed.
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address: sankar.navaneethan@bcm.edu.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Mandayam
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: Department of Nephrology, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D012129:Respiratory Function Tests
keywords: Lung disease; National Health and Nutrition Examination Survey (NHANES); albuminuria; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); lower respiratory disease; mortality; obstructive lung function; renal function; restrictive lung function; spirometry; urine albumin-creatinine ratio (UACR)