Abstract
BackgroundDespite the interrelationships between obesity, eGFR and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes.MethodsWe examined the joint associations between obesity, eGFR and albuminuria on four clinical outcomes (death, end-stage renal disease [ESRD], myocardial infarction [MI], and placement in a long-term care facility) using a population-based cohort with procedures from Alberta. Obesity was defined by body mass index ≥35 kg/m2 as defined by a fee modifier applied to an eligible procedure.ResultsWe studied 1,293,362 participants, of whom 171,650 (13.3%) had documented obesity (BMI ≥ 35 kg/m2 based on claims data) and 1,121,712 (86.7%) did not. The association between eGFR and death was J-shaped for participants with and without documented obesity. After full adjustment, obesity tended to be associated with slightly lower odds of mortality (OR range 0.71–1.02; p for interaction between obesity and eGFR 0.008). For participants with and without obesity, the adjusted odds of ESRD were lowest for participants with eGFR > 90 mL/min*1.73m2 and increased with lower eGFR, with no evidence of an interaction with obesity (p = 0.37). Although albuminuria and obesity were both associated with higher odds of ESRD, the excess risk associated with obesity was substantially attenuated at higher levels of albuminuria (p for interaction 0.0006). The excess risk of MI associated with obesity was observed at eGFR > 60 mL/min*1.73m2 but not at lower eGFR (p for interaction < 0.0001). Participants with obesity had a higher adjusted likelihood of placement in long-term care than those without, and the likelihood of such placement was higher at lower eGFR for those with and without obesity (p for interaction = 0.57).ConclusionsWe found significant interactions between obesity and eGFR and/or albuminuria on the likelihood of adverse outcomes including death and ESRD. Since obesity is common, risk prediction tools for people with CKD might be improved by adding information on BMI or other proxies for body size in addition to eGFR and albuminuria.
Highlights
Despite the interrelationships between obesity, estimated glomerular filtration rate (eGFR) and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes
What were the most important findings? The excess risk of death at lower eGFR was modestly lower in people with obesity than in otherwise similar people without obesity
The excess risk of placement in long-term care associated with lower eGFR was modestly greater among people with obesity than without obesity, and the excess risk of progression to kidney failure among people with more severe albuminuria was attenuated in those who had obesity
Summary
Despite the interrelationships between obesity, eGFR and albuminuria, few large studies examine how obesity modifies the association between these markers of kidney function and adverse clinical outcomes. Despite these interrelationships between obesity, eGFR and albuminuria, few large studies examine the joint associations between obesity, markers of kidney function and adverse clinical outcomes This information is potentially important because current tools for estimating prognosis in people with CKD generally do not include information on the presence or absence of obesity [12]. We did this large population-based study of more than 1 million people treated in a universal healthcare system to examine the joint associations between obesity, eGFR and albuminuria on four clinical outcomes (death, ESRD, myocardial infarction [MI], and placement in a long-term care facility). Our primary goal was to determine whether the excess risk associated with low eGFR and albuminuria was increased or reduced by the simultaneous presence of obesity
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