Association Between Midlife Obesity and Kidney Function Trajectories: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Rationale & objective: Obesity has been related to risk for chronic kidney disease. However, the associations of different measures of midlife obesity with long-term kidney function trajectories and whether they differ by sex and race are unknown.

Study design: Observational study.

Setting & participants: 13,496 participants from the Atherosclerosis Risk in Communities (ARIC) Study.

Predictors: Midlife obesity status as measured by body mass index (BMI), waist-to-hip ratio, and predicted percent fat at baseline.

Outcomes: Estimated glomerular filtration rate (eGFR) calculated using serum creatinine level measured at 5 study visits, and incident kidney failure with replacement therapy (KFRT).

Analytical approach: Mixed models with random intercepts and random slopes for eGFR. Cox proportional hazards models for KFRT.

Results: Baseline mean age was 54 years, median eGFR was 103mL/min/1.73m², and median BMI was 27kg/m². Over 30 years of follow-up, midlife obesity measures were associated with eGFR decline in White and Black women but not consistently in men. Adjusted for age, center, smoking, and coronary heart disease, the differences in eGFR slope per 1-SD higher BMI, waist-to-hip ratio, and predicted percent fat were 0.09 (95% CI, -0.18 to 0.36), -0.25 (95% CI, -0.50 to 0.01), and-0.14 (95% CI, -0.41 to 0.13) mL/min/1.73m² per decade for White men; -0.91 (95% CI, -1.15 to-0.67), -0.82 (95% CI, -1.06 to-0.58), and-1.02 (95% CI, -1.26 to-0.78) mL/min/1.73m² per decade for White women; -0.70 (95% CI, -1.54 to 0.14), -1.60 (95% CI, -2.42 to-0.78), and-1.24 (95% CI, -2.08 to-0.40) mL/min/1.73m² per decade for Black men; and-1.24 (95% CI, -2.08 to-0.40), -1.50 (95% CI, -2.05 to-0.95), and-1.43 (95% CI, -2.00 to-0.86) mL/min/1.73m² per decade for Black women. Obesity indicators were independently associated with risk for KFRT for all sex-race groups except White men.

Limitations: Loss to follow-up during 3 decades of follow-up with 5 eGFR assessments.

Conclusions: Obesity status is a risk factor for future decline in kidney function and development of KFRT in Black and White women, with less consistent associations among men.

Keywords: Obesity; bioelectrical impedance analysis (BIA); body fat; body mass index (BMI); chronic kidney disease (CKD); end-stage renal disease (ESRD); estimated glomerular filtration rate (eGFR); kidney disease progression; kidney failure; kidney function; midlife; modifiable risk factor; racial/ethnic differences; sex differences; trajectory; waist-to-hip ratio.

Figure 1.

Distribution of unadjusted predicted average annual change in estimated glomerular filtration rate (eGFR; mL/min/1.73 m²) within the Atherosclerosis Risk in Communities (ARIC) population according to baseline obesity marker tertile by sex and race. (A) Annual eGFR change according to body mass index (BMI) tertile among (left to right) White men, White women, Black men, and Black women. (B) Annual eGFR change according to waist-to-hip ratio tertile among (left to right) White men, White women, Black men, and Black women. (C) Annual eGFR change according to baseline predicted percent fat tertile among (left to right) White men, White women, Black men, and Black women.