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, 20 (1), 204

Joint Associations of Obesity and Estimated GFR With Clinical Outcomes: A Population-Based Cohort Study

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Joint Associations of Obesity and Estimated GFR With Clinical Outcomes: A Population-Based Cohort Study

Marcello Tonelli et al. BMC Nephrol.

Abstract

Background: Despite the interrelationships between obesity, eGFR and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes.

Methods: We examined the joint associations between obesity, eGFR and albuminuria on four clinical outcomes (death, end-stage renal disease [ESRD], myocardial infarction [MI], and placement in a long-term care facility) using a population-based cohort with procedures from Alberta. Obesity was defined by body mass index ≥35 kg/m2 as defined by a fee modifier applied to an eligible procedure.

Results: We studied 1,293,362 participants, of whom 171,650 (13.3%) had documented obesity (BMI ≥ 35 kg/m2 based on claims data) and 1,121,712 (86.7%) did not. The association between eGFR and death was J-shaped for participants with and without documented obesity. After full adjustment, obesity tended to be associated with slightly lower odds of mortality (OR range 0.71-1.02; p for interaction between obesity and eGFR 0.008). For participants with and without obesity, the adjusted odds of ESRD were lowest for participants with eGFR > 90 mL/min*1.73m2 and increased with lower eGFR, with no evidence of an interaction with obesity (p = 0.37). Although albuminuria and obesity were both associated with higher odds of ESRD, the excess risk associated with obesity was substantially attenuated at higher levels of albuminuria (p for interaction 0.0006). The excess risk of MI associated with obesity was observed at eGFR > 60 mL/min*1.73m2 but not at lower eGFR (p for interaction < 0.0001). Participants with obesity had a higher adjusted likelihood of placement in long-term care than those without, and the likelihood of such placement was higher at lower eGFR for those with and without obesity (p for interaction = 0.57).

Conclusions: We found significant interactions between obesity and eGFR and/or albuminuria on the likelihood of adverse outcomes including death and ESRD. Since obesity is common, risk prediction tools for people with CKD might be improved by adding information on BMI or other proxies for body size in addition to eGFR and albuminuria.

Keywords: Albuminuria; Obesity; eGFR.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Associations of glomerular filtration rates and albuminuria with mortality, odds ratio and 95% confidence limits by documented obesity. eGFR estimated glomerular filtration rate. The top-left panel a) shows the age-sex adjusted association of glomerular filtration rates with mortality by documented obesity (interaction term P = 0.002). The top-right panel b) shows the fully adjusted association of glomerular filtration rates with mortality by documented obesity (interaction term P = 0.008). The bottom-left panel c) shows the age-sex adjusted association of albuminuria with mortality by documented obesity (interaction term P < 0.0001). The bottom-right panel d) shows the fully adjusted association of albuminuria with mortality by documented obesity (interaction term P < 0.0001)
Fig. 2
Fig. 2
Associations of glomerular filtration rates and albuminuria with progression to RRT, odds ratio and 95% confidence limits by documented obesity. eGFR estimated glomerular filtration rate, RRT renal replacement therapy. The left panel a) shows the fully adjusted association of glomerular filtration rates with progression to RRT by documented obesity (interaction term P = 0.10). The right panel b) shows the fully adjusted association of albuminuria with progression to RRT by documented obesity (interaction term P = 0.37)
Fig. 3
Fig. 3
Associations of glomerular filtration rates with myocardial infarction and placement in long-term care, odds ratio and 95% confidence limits by documented obesity. eGFR estimated glomerular filtration rate. The left panel a) shows the fully adjusted association of glomerular filtration rates with myocardial infarction by documented obesity (interaction term P < 0.0001). The right panel b) shows the fully adjusted association of glomerular filtration rates with placement in long-term care by documented obesity (interaction term P < 0.0001)

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