Lung Function and Incident Kidney Disease

The Atherosclerosis Risk in Communities (ARIC) Study

Keiichi Sumida, Lucia Kwak, Morgan E. Grams, Kunihiro Yamagata, Naresh M. Punjabi, Csaba Kovesdy, Josef Coresh, Kunihiro Matsushita

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80% and FEV1/FVC < 70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80% and FEV1/FVC ≥ 70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80% and FEV1/FVC < 70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC ≥ 70%, or percent-predicted FVC ≥ 80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

Original languageEnglish (US)
Pages (from-to)675-685
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number5
DOIs
StatePublished - Nov 1 2017

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Vital Capacity
Kidney Diseases
Atherosclerosis
Lung
Chronic Renal Insufficiency
Chronic Kidney Failure
Spirometry
Renal Replacement Therapy
Forced Expiratory Volume
Glomerular Filtration Rate

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Lung Function and Incident Kidney Disease : The Atherosclerosis Risk in Communities (ARIC) Study. / Sumida, Keiichi; Kwak, Lucia; Grams, Morgan E.; Yamagata, Kunihiro; Punjabi, Naresh M.; Kovesdy, Csaba; Coresh, Josef; Matsushita, Kunihiro.

In: American Journal of Kidney Diseases, Vol. 70, No. 5, 01.11.2017, p. 675-685.

Research output: Contribution to journalArticle

Sumida, K, Kwak, L, Grams, ME, Yamagata, K, Punjabi, NM, Kovesdy, C, Coresh, J & Matsushita, K 2017, 'Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study', American Journal of Kidney Diseases, vol. 70, no. 5, pp. 675-685. https://doi.org/10.1053/j.ajkd.2017.05.021
Sumida, Keiichi ; Kwak, Lucia ; Grams, Morgan E. ; Yamagata, Kunihiro ; Punjabi, Naresh M. ; Kovesdy, Csaba ; Coresh, Josef ; Matsushita, Kunihiro. / Lung Function and Incident Kidney Disease : The Atherosclerosis Risk in Communities (ARIC) Study. In: American Journal of Kidney Diseases. 2017 ; Vol. 70, No. 5. pp. 675-685.
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title = "Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study",
abstract = "Background Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0{\%} men and 25.2{\%} black), with follow-up through 2012. Predictors Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25{\%} decline in estimated glomerular filtration rate to a level <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results During a median follow-up of 23.6 years, 526 (3.5{\%}) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95{\%} CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95{\%} CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80{\%} and FEV1/FVC < 70{\%}; 3.4{\%} of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95{\%} CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80{\%} and FEV1/FVC ≥ 70{\%}; 4.8{\%} of participants) at 2.03 (95{\%} CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80{\%} and FEV1/FVC < 70{\%}; 18.9{\%} of participants) at 1.47 (95{\%} CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80{\%}-<100{\%} and FEV1/FVC ≥ 70{\%}, or percent-predicted FVC ≥ 80{\%} and FEV1/FVC 70{\%}-<75{\%}; 44.3{\%} of participants) at 1.21 (95{\%} CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.",
author = "Keiichi Sumida and Lucia Kwak and Grams, {Morgan E.} and Kunihiro Yamagata and Punjabi, {Naresh M.} and Csaba Kovesdy and Josef Coresh and Kunihiro Matsushita",
year = "2017",
month = "11",
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language = "English (US)",
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TY - JOUR

T1 - Lung Function and Incident Kidney Disease

T2 - The Atherosclerosis Risk in Communities (ARIC) Study

AU - Sumida, Keiichi

AU - Kwak, Lucia

AU - Grams, Morgan E.

AU - Yamagata, Kunihiro

AU - Punjabi, Naresh M.

AU - Kovesdy, Csaba

AU - Coresh, Josef

AU - Matsushita, Kunihiro

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80% and FEV1/FVC < 70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80% and FEV1/FVC ≥ 70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80% and FEV1/FVC < 70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC ≥ 70%, or percent-predicted FVC ≥ 80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

AB - Background Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60 mL/min/1.73 m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC < 80% and FEV1/FVC < 70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC < 80% and FEV1/FVC ≥ 70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC ≥ 80% and FEV1/FVC < 70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC ≥ 70%, or percent-predicted FVC ≥ 80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

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