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Comparative Study
. 2015 Feb 6;10(2):241-50.
doi: 10.2215/CJN.02860314. Epub 2014 Dec 1.

Adiposity patterns and the risk for ESRD in postmenopausal women

Nora Franceschini  1 , Natalia A Gouskova  2 , Alex P Reiner  3 , Andrew Bostom  4 , Barbara V Howard  5 , Mary Pettinger  6 , Jason G Umans  5 , M Alan Brookhart  7 , Wolfgang C Winkelmayer  8 , Charles B Eaton  4 , Gerardo Heiss  7 , Jason P Fine  2
Affiliations
Comparative Study

Adiposity patterns and the risk for ESRD in postmenopausal women

Nora Franceschini et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Body mass index and waist circumference associate with adverse health outcomes, including CKD. Studies of the association of body mass index and ESRD have been inconsistent; these adiposity measures have not been previously assessed together for ESRD risk or among postmenopausal women.

Design, settings, participants, & measurements: This was prospective cohort study of 20,117 postmenopausal women enrolled in the multiethnic cohort of the Women's Health Initiative. Body mass index and waist circumference were obtained at baseline, incident ESRD was obtained from the US Renal Data System, and all-cause death was obtained from surveillance data. A competing-risk framework was used to account for the effect of mortality before ESRD while adjusting for significant predictors and baseline kidney function. Associations of adiposity with mortality were also studied.

Results: Events included 212 patients with incident ESRD and 3104 deaths for a mean follow-up of 11.6 years. Increased waist circumference and body mass index were associated with 2.59- (95% confidence interval, 1.89 to 3.53) and 1.97-fold (95% confidence interval, 1.30 to 2.98) higher hazards of ESRD as well as 1.42- (95% confidence interval, 1.32 to 1.53) and 1.21-fold (95% confidence interval, 1.11 to 1.33) higher hazards of death, respectively, compared with the lower categories in adjusted analyses. The associations of waist circumference with ESRD varied by baseline renal function (P for interaction=0.01) and were significant only among women without baseline eGFR-defined CKD (hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.03).

Conclusions: Central obesity was associated with an increased risk of ESRD in postmenopausal women, even among women with normal body mass index but not among women with reduced baseline kidney function, and an increased risk of death. Body mass index was associated with ESRD, and the association is likely mediated through hypertension and diabetes.

Keywords: ESRD; chronic renal failure; clinical epidemiology; epidemiology and outcomes; risk factors.

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Figures

Figure 1.
Figure 1.
Cumulative incidence function estimates and 95% confidence limits for ESRD by categories of (A) body mass index (BMI) and (B) waist circumference. The test by Gray (31) for equality of cumulative incidence curves among categories of BMI (kilograms per meter2) or waist circumference (centimeters) was significant (P<0.001 for both).
Figure 2.
Figure 2.
Age-adjusted hazard ratio and 95% confidence intervals of associations with ESRD by quintiles of waist circumference for (A) the biomarker sample, (B) women without eGFR-defined CKD, and (C) women with CKD. Numbers on the x axis are the quintiles and below the mean values for each quintile. 95% CI, 95% confidence interval.
See this image and copyright information in PMC

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