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. 2021;145(3):245-255.
doi: 10.1159/000513869. Epub 2021 Mar 5.

Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies

Paras P Shah  1 , Tammy M Brady  2 , Kevin E C Meyers  3   4 , Michelle M O'Shaughnessy  5 , Keisha L Gibson  6 , Tarak Srivastava  7 , Jarcy Zee  8 , Daniel Cattran  9 , Katherine R Tuttle  10 , Crystal Gadegbeku  11 , Dorey Glenn  6 , Vimal Derebail  6 , Abigail Smith  8 , Chia-Shi Wang  12 , Brenda W Gillespie  13 , Markus Bitzer  14 , Christine B Sethna  15   16
Affiliations

Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies

Paras P Shah et al. Nephron. 2021.

Abstract

Background/aims: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized.

Methods: In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots.

Results: The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001).

Conclusion: Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.

Keywords: Body mass index; Hypertension; Nephrotic syndrome; Obesity; Pediatrics; Proteinuria.

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Figures

Figure 1.
Figure 1.
Prevalence of obesity among children and adults with proteinuric glomerulopathies enrolled in NEPTUNE. The proportion with obesity did not vary significantly over time (Cochran’s Q = 7.43, p = 0.4).
Figure 2.
Figure 2.
Prevalence of obesity and edema in adults (left) and children (right) with proteinuric glomerulopathies over time. Cochran’s Q indicated significant increase in obese nonedematous adults over time (Q = 12.96, p = 0.04). There was no significant change in obese nonedematous children over time (Q = 9.75, p = 0.1).
Figure 3.
Figure 3.
Kaplan-Meier plot of complete remission by baseline obesity status in adults. There was a significant difference in the proportion that reached remission (log-rank test p <0.001).
Figure 4.
Figure 4.
Kaplan-Meier plot of complete remission by baseline obesity status in children. There was a significant difference in the proportion that reached remission (log-rank test p <0.001).
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