Obesity is not associated with progression to end stage renal disease in patients with biopsy-proven glomerular diseases

Elyan, B. M.P., Lees, J. S. , Gillis, K. A. , Mackinnon, B., Fox, J. G., Geddes, C. C. and McQuarrie, E. P. (2019) Obesity is not associated with progression to end stage renal disease in patients with biopsy-proven glomerular diseases. BMC Nephrology, 20, 237. (doi:10.1186/s12882-019-1434-7) (PMID:31266462) (PMCID:PMC6604373)

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Abstract

Background: Body mass index (BMI) is associated with renal disease progression in unspecified CKD. The relationship between BMI and primary glomerular disease (GN) may be more complex. We aimed to evaluate the association between BMI and renal disease progression in patients with primary glomerular disease (GN). Methods: This was a single-centre retrospective cohort study performed in adult patients with biopsy-proven primary GN (excluding minimal change disease) from January 2000 to December 2015, with follow-up data until June 2017. BMI at time of biopsy was categorised as ≤25 kg/m2, > 25 to ≤30 kg/m2 and > 30 kg/m2. We used univariate and multivariate survival analyses to evaluate factors associated with progression to a composite endpoint of stage 5 CKD or renal replacement therapy (Major Adverse Renal Event - MARE) censoring for competing risk of death using Fine and Gray subdistribution hazards model. Results: We included 560 patients with biopsy-proven primary GN and available BMI data: 66.1% were male with median age 54.8 (IQR 41.1–66.2) years and BMI 28.2 (IQR 24.9–32.1) kg/m2. Those with BMI 25-30 kg/m2 (n = 210) and with BMI > 30 kg/m2 (n = 207) were older (p = 0.007) with higher systolic and diastolic blood pressures (p = 0.02 and 0.004 respectively) than those with BMI < 25 kg/m2 (n = 132). There was a greater proportion of focal segmental glomerulosclerosis in those with higher BMI (3.9% in BMI < 25 kg/m2, 7.9% in BMI 25–30 kg/m2 and 10.7% in BMI > 30 kg/m2 of biopsies (p = 0.01)), but similar proportions of other GN diagnoses across BMI groups. Baseline eGFR (p = 0.40) and uPCR (p = 0.17) were similar across BMI groups. There was no interaction between BMI and time to MARE (log-rank p = 0.98) or death (log-rank p = 0.42). Censoring for competing risk of death, factors associated with progression to MARE were: younger age, lower baseline eGFR and higher uPCR, but not BMI (SHR 0.99, 95%CI 0.97–1.01, p = 0.31) nor blood pressure or GN diagnosis. Conclusion: BMI was not associated with progression to MARE in this patient cohort with primary GN. Efforts should be directed to managing other known risk factors for CKD progression.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mackinnon, Dr Bruce and Lees, Jennifer and Fox, Dr Jonathan and Geddes, Dr Colin and Gillis, Dr Keith and McQuarrie, Dr Emily
Authors: Elyan, B. M.P., Lees, J. S., Gillis, K. A., Mackinnon, B., Fox, J. G., Geddes, C. C., and McQuarrie, E. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMC Nephrology
Publisher:BioMed Central
ISSN:1471-2369
ISSN (Online):1471-2369
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BMC Nephrology 20:237
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3009230Vitamin K in Transplanted Kidney Organ Recipients: Investigating vEssel Stiffness (ViKTORIES)Jennifer LeesKidney Research UK (KIDNEYRE)TF_013_20161125CAMS - Cardiovascular Science
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES

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