Abstract
The relationship between body mass index (BMI) and end-stage renal disease (ESRD) may differ between blacks and whites due to underlying metabolic differences. We conducted a nested case-control study of 631 incident ESRD cases and 1,897 matched controls within the Southern Community Cohort Study. Current weight, height, and weight at age 21 were reported at enrollment. Occurrence of ESRD was ascertained by linkage with the United States Renal Data System. With normal BMI (18.5-24.9 kg/m2) as reference, conditional logistic regression was used to calculate adjusted odds ratios (OR) and corresponding 95% confidence intervals (CI) for ESRD across other BMI categories by race. In subsequent analysis, BMI at age 21 was modeled using restricted cubic splines with 5 knots. Predicted probabilities of incident ESRD were computed from the multivariable logistic models and plotted against BMI at age 21. Among blacks, odds of ESRD were significantly increased among those who were overweight (OR: 1.41; 95%CI: 1.09, 1.83) or obese (OR: 2.56; 95%CI: 1.88, 3.47) at age 21. Among whites, the association between ESRD and BMI at age 21 was more pronounced, with corresponding ORs of 2.13 (95%CI: 0.92, 4.93) and 7.46 (95%CI: 2.90, 19.21; p-interaction 0.05). Only among whites was high BMI at enrollment associated with ESRD risk; OR for BMI≥40 kg/m2, was 3.31 (95%CI: 1.08, 10.12). The plot of the predicted probabilities of incident ESRD vs BMI at age 21 showed a monotonic increase in the probability of ESRD after a BMI cutoff ≈ 25Kg/m2 in both whites and blacks but the slope of the curve for whites appeared greater. Our results suggest racial differences in the relationship between BMI, both in early adulthood and middle age, and ESRD. These findings warrant further research into understanding the underlying metabolic differences that may explain these differences.
Highlights
The relationship between body mass index (BMI) and end-stage renal disease (ESRD) may differ between blacks and whites due to underlying metabolic differences
As the burden of end-stage renal disease (ESRD) in the United States (US) continues to increase [1], it remains important to understand the role of risk factors such as body mass index (BMI), which change during the course of life and which may interact with race to modify ESRD
History of dyslipidemia was reported more frequently by cases than controls, as were diagnoses of diabetes (65.1 % vs 28.5 %) or hypertension (85.7 % vs 65.5 %). These differences were similar in blacks and whites except for education and BMI at enrollment, for which we found significant differences between cases and controls in blacks but not in whites (Table 1)
Summary
The relationship between body mass index (BMI) and end-stage renal disease (ESRD) may differ between blacks and whites due to underlying metabolic differences. As the burden of end-stage renal disease (ESRD) in the United States (US) continues to increase [1], it remains important to understand the role of risk factors such as body mass index (BMI), which change during the course of life and which may interact with race to modify ESRD. To our knowledge, only one study [8], which focused on midlife BMI, has investigated whether there may be a differential relationship between BMI and ESRD in blacks and whites. We investigated whether the association between BMI in both early adulthood and midlife and ESRD is stronger among whites compared to blacks, using a nested case–control study within the SCCS For any given value of BMI, whites tend to have higher percent body fat than blacks [18], and adiposity has been demonstrated to have different metabolic effects in whites and blacks [19,20,21,22].
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