Obesity and change in estimated GFR among older adults.

de Boer IH, Katz R, Fried LF, Ix JH, Luchsinger J, Sarnak MJ, Shlipak MG, Siscovick DS, Kestenbaum B. Obesity and change in estimated GFR among older adults. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2009 Dec 1; 54(6):1043-51.

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Abstract:

BACKGROUND: The prevalence of chronic kidney disease is growing most rapidly among older adults; however, determinants of impaired kidney function in this population are not well understood. Obesity assessed in midlife has been associated with chronic kidney disease. STUDY DESIGN: Cohort study. SETTING and PARTICIPANTS: 4,295 participants in the community-based Cardiovascular Health Study, aged > or = 65 years. PREDICTORS: Body mass index, waist circumference, and fat mass measured using bioelectrical impedance. OUTCOME: Change in glomerular filtration rate (GFR) during 7 years of follow-up. MEASUREMENTS: Longitudinal estimates of GFR calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. RESULTS: Estimated GFR decreased by an average of 0.4 +/- 3.6 mL/min/1.73 m(2)/y, and rapid GFR loss ( > 3 mL/min/1.73 m(2)/y) occurred in 693 participants (16%). Baseline body mass index, waist circumference, and fat mass were each associated with increased risk of rapid GFR loss: ORs, 1.19 (95% CI, 1.09-1.30) per 5 kg/m(2), 1.25 (95% CI, 1.16-1.36) per 12 cm, and 1.14 (95% CI, 1.05-1.24) per 10 kg after adjustment for age, sex, race, and smoking. The magnitude of increased risk was larger for participants with estimated GFR < 60 mL/min/1.73 m(2) at baseline (P for interaction < 0.05). Associations were substantially attenuated by further adjustment for diabetes, hypertension, and C-reactive protein level. Obesity measurements were not associated with change in GFR estimated using serum cystatin C level. LIMITATIONS: Few participants with advanced chronic kidney disease at baseline, no direct GFR measurements. CONCLUSION: Obesity may be a modifiable risk factor for the development and progression of kidney disease in older adults.