Association of age and BMI with kidney function and mortality

A cohort study

Jun Ling Lu, Miklos Z. Molnar, Adnan Naseer, Margit K. Mikkelsen, Kamyar Kalantar-Zadeh, Csaba Kovesdy

Research output: Contribution to journalArticle

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Abstract

Background: Compared with normal weight, obesity might be associated with worse clinical outcomes, including chronic kidney disease. Whether this association is modified by age is not known. We investigated the association of BMI with progressive loss of kidney function and all-cause mortality in US veterans. Methods: In a national cohort of 3 376 187 US veterans with an estimated glomerular filtration rate (eGFR) of more than 60 mL/min per 1·73 m 2 , we assessed the association of BMI in patients of different ages (<40 years, 40 years to <50 years, 50 years to <60 years, 60 years to <70 years, 70 years to <80 years, and ≥80 years) with loss of kidney function and with all-cause mortality in logistic regression models and Cox proportional hazards models adjusted for ethnic origin, sex, comorbidities, medications, and baseline eGFR. Findings: 274 764 (8·1%) of 3 376 187 veterans had a rapid decline in kidney function (decrease in slope of >5 mL/min per 1·73 m 2 ). The lowest risk for loss of kidney function was noted in patients with BMI of at least 25 kg/m 2 but less than 30 kg/m 2 . A generally consistent U-shaped association was noted between BMI and rapid loss of kidney function that was more prominent with increasing age, except in the patients younger than 40 years, in whom BMI did not seem to be predictive of renal function impairment. 672 341 veterans died (28·7 per 1000 patient-years, 95% CI 28·6-28·7) over a median follow-up of 6·8 years (IQR 6·5-7·7). BMI also showed a U-shaped association with mortality, which was similar in all age groups. Interpretation: A BMI of 30 kg/m 2 or more is associated with rapid loss of kidney function in patients with eGFR of at least 60 mL/min per 1·73 m 2 , and this association is accentuated in older patients. A BMI of 35 kg/m 2 or more is also associated with high mortality. A BMI of at least 25 kg/m 2 but less than 30 kg/m 2 is associated with the best clinical outcomes. Funding: National Institute of Health, Memphis VA Medical Center, Long Beach VA Healthcare System, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center.

Original languageEnglish (US)
Pages (from-to)704-714
Number of pages11
JournalThe Lancet Diabetes and Endocrinology
Volume3
Issue number9
DOIs
StatePublished - Sep 1 2015

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Cohort Studies
Veterans
Kidney
Mortality
Glomerular Filtration Rate
Veterans Health
Information Centers
United States Department of Veterans Affairs
Health Services Research
National Institutes of Health (U.S.)
Chronic Renal Insufficiency
Research
Age Groups
Obesity
Delivery of Health Care
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Association of age and BMI with kidney function and mortality : A cohort study. / Lu, Jun Ling; Molnar, Miklos Z.; Naseer, Adnan; Mikkelsen, Margit K.; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: The Lancet Diabetes and Endocrinology, Vol. 3, No. 9, 01.09.2015, p. 704-714.

Research output: Contribution to journalArticle

Lu, Jun Ling ; Molnar, Miklos Z. ; Naseer, Adnan ; Mikkelsen, Margit K. ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Association of age and BMI with kidney function and mortality : A cohort study. In: The Lancet Diabetes and Endocrinology. 2015 ; Vol. 3, No. 9. pp. 704-714.
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N2 - Background: Compared with normal weight, obesity might be associated with worse clinical outcomes, including chronic kidney disease. Whether this association is modified by age is not known. We investigated the association of BMI with progressive loss of kidney function and all-cause mortality in US veterans. Methods: In a national cohort of 3 376 187 US veterans with an estimated glomerular filtration rate (eGFR) of more than 60 mL/min per 1·73 m 2 , we assessed the association of BMI in patients of different ages (<40 years, 40 years to <50 years, 50 years to <60 years, 60 years to <70 years, 70 years to <80 years, and ≥80 years) with loss of kidney function and with all-cause mortality in logistic regression models and Cox proportional hazards models adjusted for ethnic origin, sex, comorbidities, medications, and baseline eGFR. Findings: 274 764 (8·1%) of 3 376 187 veterans had a rapid decline in kidney function (decrease in slope of >5 mL/min per 1·73 m 2 ). The lowest risk for loss of kidney function was noted in patients with BMI of at least 25 kg/m 2 but less than 30 kg/m 2 . A generally consistent U-shaped association was noted between BMI and rapid loss of kidney function that was more prominent with increasing age, except in the patients younger than 40 years, in whom BMI did not seem to be predictive of renal function impairment. 672 341 veterans died (28·7 per 1000 patient-years, 95% CI 28·6-28·7) over a median follow-up of 6·8 years (IQR 6·5-7·7). BMI also showed a U-shaped association with mortality, which was similar in all age groups. Interpretation: A BMI of 30 kg/m 2 or more is associated with rapid loss of kidney function in patients with eGFR of at least 60 mL/min per 1·73 m 2 , and this association is accentuated in older patients. A BMI of 35 kg/m 2 or more is also associated with high mortality. A BMI of at least 25 kg/m 2 but less than 30 kg/m 2 is associated with the best clinical outcomes. Funding: National Institute of Health, Memphis VA Medical Center, Long Beach VA Healthcare System, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center.

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