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Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway.
Am J Kidney Dis. 2009 Oct; 54(4):638-46.AJ

Abstract

BACKGROUND

The combined effect of blood pressure (BP) and body weight on risk of kidney disease has not been previously studied. To improve risk stratification in prehypertensive individuals (ie, BP, 120 to 139/80 to 89 mm Hg), we examined the interaction between BP and body weight on the risk of end-stage renal disease or chronic kidney disease (CKD)-related death.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

74,986 adults participating in the first Health Study in Nord-Trøndelag (88% participation rate) were linked to the Norwegian Renal Registry and Cause of Death Registry.

PREDICTORS

BP and body weight were measured by using standard procedures, and other relevant covariates were obtained from an extensive questionnaire.

OUTCOME & MEASUREMENTS

Hazard ratios for treated end-stage renal disease and CKD-related death were calculated.

RESULTS

Mean systolic BP and body mass index (BMI) were 136.8 +/- 23.3 (SD) mm Hg and 25.2 +/- 3.9 kg/m(2), whereas 12.9% had treated hypertension at baseline, respectively. During a median follow-up of 21 years (1,345,882 person-years), 507 men (1.4%) and 319 women (0.8%) initiated renal replacement therapy (n = 157) or died of CKD (n = 669). Multiadjusted risk of these kidney outcomes increased continuously with no lower threshold for BP. The risk associated with body weight started to increase from a BMI of 25.0 kg/m(2). In participants with BP less than 120/80 mm Hg, risk did not increase with increasing BMI. In prehypertensive participants, multivariate adjusted hazard ratios in the BMI categories 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and 35.0 kg/m(2) or greater were 1.21 (95% confidence interval [CI], 0.67 to 2.17), 1.10 (95% CI, 59 to 2.00), 2.66 (95% CI, 1.28 to 5.53), and 5.94 (95% CI, 1.94 to 18.20) compared with BP less than 120/80 mm Hg and BMI of 18.5 to 24.9 kg/m(2), respectively (P = 0.02 for trend). Corresponding risks in hypertensive participants were 2.13 (95% CI, 1.23 to 3.70), 2.40 (95% CI, 1.40 to 4.15), 3.32 (95% CI, 1.89 to 5.81), and 5.53 (95% CI, 3.01 to 10.20), respectively (P < 0.001 for trend).

LIMITATIONS

Baseline creatinine measurements were not available; hence, a secondary analysis was performed that excluded all individuals who experienced outcomes in the 5 years after the study start.

CONCLUSIONS

Participants with prehypertension are not at increased risk of serious kidney outcomes if BMI is less than 30.0 kg/m(2). However, the risk of kidney disease increases substantially if prehypertension is present in obese participants.

Authors+Show Affiliations

Faculty of Medicine, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. john@munkhaugen.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19515474

Citation

Munkhaugen, John, et al. "Prehypertension, Obesity, and Risk of Kidney Disease: 20-year Follow-up of the HUNT I Study in Norway." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 54, no. 4, 2009, pp. 638-46.
Munkhaugen J, Lydersen S, Widerøe TE, et al. Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. Am J Kidney Dis. 2009;54(4):638-46.
Munkhaugen, J., Lydersen, S., Widerøe, T. E., & Hallan, S. (2009). Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 54(4), 638-46. https://doi.org/10.1053/j.ajkd.2009.03.023
Munkhaugen J, et al. Prehypertension, Obesity, and Risk of Kidney Disease: 20-year Follow-up of the HUNT I Study in Norway. Am J Kidney Dis. 2009;54(4):638-46. PubMed PMID: 19515474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. AU - Munkhaugen,John, AU - Lydersen,Stian, AU - Widerøe,Tor-Erik, AU - Hallan,Stein, Y1 - 2009/06/10/ PY - 2008/11/28/received PY - 2009/03/27/accepted PY - 2009/6/12/entrez PY - 2009/6/12/pubmed PY - 2009/10/3/medline SP - 638 EP - 46 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 54 IS - 4 N2 - BACKGROUND: The combined effect of blood pressure (BP) and body weight on risk of kidney disease has not been previously studied. To improve risk stratification in prehypertensive individuals (ie, BP, 120 to 139/80 to 89 mm Hg), we examined the interaction between BP and body weight on the risk of end-stage renal disease or chronic kidney disease (CKD)-related death. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 74,986 adults participating in the first Health Study in Nord-Trøndelag (88% participation rate) were linked to the Norwegian Renal Registry and Cause of Death Registry. PREDICTORS: BP and body weight were measured by using standard procedures, and other relevant covariates were obtained from an extensive questionnaire. OUTCOME & MEASUREMENTS: Hazard ratios for treated end-stage renal disease and CKD-related death were calculated. RESULTS: Mean systolic BP and body mass index (BMI) were 136.8 +/- 23.3 (SD) mm Hg and 25.2 +/- 3.9 kg/m(2), whereas 12.9% had treated hypertension at baseline, respectively. During a median follow-up of 21 years (1,345,882 person-years), 507 men (1.4%) and 319 women (0.8%) initiated renal replacement therapy (n = 157) or died of CKD (n = 669). Multiadjusted risk of these kidney outcomes increased continuously with no lower threshold for BP. The risk associated with body weight started to increase from a BMI of 25.0 kg/m(2). In participants with BP less than 120/80 mm Hg, risk did not increase with increasing BMI. In prehypertensive participants, multivariate adjusted hazard ratios in the BMI categories 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, and 35.0 kg/m(2) or greater were 1.21 (95% confidence interval [CI], 0.67 to 2.17), 1.10 (95% CI, 59 to 2.00), 2.66 (95% CI, 1.28 to 5.53), and 5.94 (95% CI, 1.94 to 18.20) compared with BP less than 120/80 mm Hg and BMI of 18.5 to 24.9 kg/m(2), respectively (P = 0.02 for trend). Corresponding risks in hypertensive participants were 2.13 (95% CI, 1.23 to 3.70), 2.40 (95% CI, 1.40 to 4.15), 3.32 (95% CI, 1.89 to 5.81), and 5.53 (95% CI, 3.01 to 10.20), respectively (P < 0.001 for trend). LIMITATIONS: Baseline creatinine measurements were not available; hence, a secondary analysis was performed that excluded all individuals who experienced outcomes in the 5 years after the study start. CONCLUSIONS: Participants with prehypertension are not at increased risk of serious kidney outcomes if BMI is less than 30.0 kg/m(2). However, the risk of kidney disease increases substantially if prehypertension is present in obese participants. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/19515474/Prehypertension_obesity_and_risk_of_kidney_disease:_20_year_follow_up_of_the_HUNT_I_study_in_Norway_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)00719-7 DB - PRIME DP - Unbound Medicine ER -