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ARTICLE

Body Mass Index and Risk for End-Stage Renal Disease

Chi-yuan Hsu, MD, MSc; Charles E. McCulloch, PhD; Carlos Iribarren, MD, MPH, PhD; Jeanne Darbinian, MPH; and Alan S. Go, MD

3 January 2006 | Volume 144 Issue 1 | Pages 21-28

Background: Although interest in the relationship between obesity and kidney disease is increasing, few epidemiologic studies have examined whether excess weight is an independent risk factor for end-stage renal disease (ESRD).

Objective: To determine the association between increased body mass index (BMI) and risk for ESRD.

Design: Historical (nonconcurrent) cohort study.

Setting: A large integrated health care delivery system in northern California.

Participants: 320 252 adult members of Kaiser Permanente who volunteered for screening health checkups between 1964 and 1985 and who had height and weight measured.

Measurements: The authors ascertained ESRD cases by matching data with the U.S. Renal Data System registry through 2000.

Results: A total of 1471 cases of ESRD occurred during 8 347 955 person-years of follow-up. Higher BMI was a risk factor for ESRD in multivariable models that adjusted for age, sex, race, education level, smoking status, history of myocardial infarction, serum cholesterol level, urinalysis proteinuria, urinalysis hematuria, and serum creatinine level. Compared with persons who had normal weight (BMI, 18.5 to 24.9 kg/m²), the adjusted relative risk for ESRD was 1.87 (95% CI, 1.64 to 2.14) for those who were overweight (BMI, 25.0 to 29.9 kg/m²), 3.57 (CI, 3.05 to 4.18) for those with class I obesity (BMI, 30.0 to 34.9 kg/m²), 6.12 (CI, 4.97 to 7.54) for those with class II obesity (BMI, 35.0 to 39.9 kg/m²), and 7.07 (CI, 5.37 to 9.31) for those with extreme obesity (BMI 40 kg/m²). Higher baseline BMI remained an independent predictor for ESRD after additional adjustments for baseline blood pressure level and presence or absence of diabetes mellitus.

Limitations: Primary analyses were based on single measurements of exposures.

Conclusions: High BMI is a common, strong, and potentially modifiable risk factor for ESRD.

Editors' Notes Context Few studies have asked whether obesity affects the risk for end-stage renal disease (ESRD). Contribution In this retrospective cohort study of 320 252 adults who were followed for 15 to 35 years, the rate of ESRD increased in a stepwise manner as body mass index (BMI) increased. Age-, sex-, and race-adjusted rates of ESRD increased from 10 per 100 000 person-years among those with normal weight (BMI, 18.5 to 24.9 kg/m2) to 108 per 100 000 among those with extreme obesity (BMI 40 kg/m2). This relationship was not affected by blood pressure levels or diabetes. Cautions Body mass index and potential confounders were measured only at baseline. Implications High BMI is a potentially modifiable risk factor for ESRD. —The Editors

 

Author and Article Information

From the University of California, San Francisco, San Francisco, California, and Kaiser Permanente of Northern California, Oakland, California.

Disclaimer: Some data were supplied by the U.S. Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.

Acknowledgment: The authors thank Mr. Shu-Cheng Chen of the U.S. Renal Data System for his assistance.

Grant Support: By the National Institutes of Health (grants HL71074 and DK61520).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Chi-yuan Hsu, MD, MSc, Division of Nephrology, University of California, San Francisco, 513 Parnassus Avenue, 672 HSE, Box 0532, San Francisco, CA 94143-0532; e-mail, hsuchi{at}medicine.ucsf.edu.

Current Author Addresses: Dr. Hsu: Division of Nephrology, University of California, San Francisco, 513 Parnassus Avenue, 672 HSE, Box 0532, San Francisco, CA 94143-0532.

Dr. McCulloch: Department of Epidemiology and Biostatistics, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143.

Drs. Iribarren and Go and Ms. Darbinian: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612.

Author Contributions: Conception and design: C.-Y. Hsu, C. Iribarren, A.S. Go.

Analysis and interpretation of the data: C.-Y. Hsu, C.E. McCulloch, J. Darbinian, A.S. Go.

Drafting of the article: C.-Y. Hsu.

Critical revision of the article for important intellectual content: C.-Y. Hsu, C.E. McCulloch, C. Iribarren, J. Darbinian, A.S. Go.

Final approval of the article: C.-Y. Hsu, C.E. McCulloch, C. Iribarren, J. Darbinian, A.S. Go.

Statistical expertise: C.-Y. Hsu, C.E. McCulloch.

Obtaining of funding: C.-Y. Hsu, C. Iribarren, A.S. Go.

Administrative, technical, or logistic support: C.-Y. Hsu, A.S. Go.

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