title: Association of anthropometric measures with kidney disease progression and mortality: a retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service.
abstract: Although elevated body mass index (BMI) is a predictor of better clinical outcomes in dialysis patients, the evidence in pre-dialysis chronic kidney disease (CKD) is conflicting. Clinical measures of central obesity may be better prognostic indicators, although investigation has been limited. The aim of this study was to assess the predictive value of anthropometric measures for kidney failure progression and mortality in stage 3-4 CKD.
  
  
  
  The study included newly referred stage 3-4 CKD patients at a single centre between 1/1/2008 and 31/12/2010. The associations between clinical measures of obesity (BMI, waist circumference [WC] and conicity index [ConI]) and time to a composite primary outcome of doubling of serum creatinine, commencement of renal replacement therapy or mortality were evaluated using the Kaplan-Meier method and multivariable Cox regression models.
  
  
  
  Over a median follow-up period of 3.3 years, 229 (25.4 %) patients of a total population of 903 experienced the composite primary renal outcome. When compared to normal BMI (18.5-24.9 kg/m(2), n = 174), the risk of the composite primary outcome was significantly lower in both the overweight (BMI 25-29.9 kg/m(2), n = 293; adjusted hazard ratio [HR] 0.50, 95 % CI 0.33-0.75) and obese class I/II groups (BMI 30-39.9 kg/m(2), n = 288; HR 0.62, 95 % CI 0.41-0.93), but not in the obese class III group (BMI ≥40 kg/m(2), n = 72; HR 0.94, 95 % CI 0.52-1.69). All-cause mortality was also lower in the overweight group (HR 0.50, 95 % CI 0.30-0.83). WC and ConI were not associated with either the composite primary outcome or mortality.
  
  
  
  BMI in the overweight range is associated with reduced risks of kidney disease progression and all-cause mortality in stage 3-4 CKD. WC and ConI were not independent predictors of these outcomes in this population.
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia. emma.davis@uqconnect.edu.au.
authors.forename: Emma
authors.identifier: 0000-0001-8719-7114
authors.initials: E
authors.lastname: Davis
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Campbell
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia.
authors.forename: Glenda
authors.initials: G
authors.lastname: Gobe
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.|Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: Carmel
authors.initials: C
authors.lastname: Hawley
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Isbel
authors.affiliation: Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, QLD, Australia.|Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.|Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D015992:Body Mass Index; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011793:Queensland / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012737:Sex Factors; D055105:Waist Circumference
chemical_list: D003404:Creatinine
keywords: Anthropometry; Body mass index; Chronic kidney disease; Conicity index; Mortality; Waist circumference