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Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.
Am J Kidney Dis. 2016 Jan; 67(1):62-9.AJ

Abstract

BACKGROUND

The association between waist circumference and end-stage renal disease (ESRD) remains poorly explored.

STUDY DESIGN

Longitudinal population-based cohort.

SETTING & PARTICIPANTS

Participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study (n=30,239) with information for body mass index (BMI), waist circumference, spot urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR; n=26,960).

PREDICTOR

Elevated waist circumference or BMI.

OUTCOMES & MEASUREMENTS

Incident cases of ESRD were identified through linkage of REGARDS participants with the US Renal Data System.

RESULTS

Mean baseline age was 64.8 years, 45.8% were men, and 40.3% were black. Overall, 297 (1.1%) individuals developed ESRD during a median of 6.3 years. After adjustment for all covariates including waist circumference, no significant association was noted between BMI categories and ESRD incidence compared to BMI of 18.5 to 24.9 kg/m2 (referent). Higher waist circumference categories showed significantly increased hazard rates of ESRD, with waist circumference ≥ 108 cm in women and ≥122 cm in men (highest category) showing a 3.97-fold higher hazard rate (95% CI, 2.10-6.86) for ESRD compared to waist circumference < 80 cm in women and <94 cm in men (referent) after adjusting for demographic factors and BMI. However, no significant association was noted between any waist circumference category and ESRD incidence after adjustment for obesity-associated comorbid conditions and baseline ACR and eGFR.

LIMITATIONS

Short follow-up period (6.3 years) to assess ESRD risk among adults with eGFRs>60 mL/min/1.73 m2.

CONCLUSIONS

In this cohort of older adults, obesity as measured by waist circumference is associated with higher ESRD risk even with adjustment for BMI, whereas obesity as measured by BMI is not associated with higher ESRD risk after adjustment for waist circumference. However, no significant association is noted between increased waist circumference and ESRD risk after adjustment for obesity-related comorbid conditions, eGFR, and ACR.

Authors+Show Affiliations

Department of Public Health Sciences, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL; Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL. Electronic address: hkramer@luc.edu.Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.Department of Public Health Sciences, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL.Department of Medicine, Emory University, Atlanta, GA; Department of Epidemiology, Emory University, Atlanta, GA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26187471

Citation

Kramer, Holly, et al. "Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 67, no. 1, 2016, pp. 62-9.
Kramer H, Gutiérrez OM, Judd SE, et al. Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2016;67(1):62-9.
Kramer, H., Gutiérrez, O. M., Judd, S. E., Muntner, P., Warnock, D. G., Tanner, R. M., Panwar, B., Shoham, D. A., & McClellan, W. (2016). Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 67(1), 62-9. https://doi.org/10.1053/j.ajkd.2015.05.023
Kramer H, et al. Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2016;67(1):62-9. PubMed PMID: 26187471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. AU - Kramer,Holly, AU - Gutiérrez,Orlando M, AU - Judd,Suzanne E, AU - Muntner,Paul, AU - Warnock,David G, AU - Tanner,Rikki M, AU - Panwar,Bhupesh, AU - Shoham,David A, AU - McClellan,William, Y1 - 2015/07/15/ PY - 2015/01/26/received PY - 2015/05/18/accepted PY - 2015/7/19/entrez PY - 2015/7/19/pubmed PY - 2016/5/3/medline KW - Adiposity KW - US Renal Data System (USRDS) KW - body mass index (BMI) KW - chronic kidney disease (CKD) KW - chronic renal failure KW - dialysis KW - end-stage renal disease (ESRD) KW - obesity KW - renal failure KW - waist circumference SP - 62 EP - 9 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 67 IS - 1 N2 - BACKGROUND: The association between waist circumference and end-stage renal disease (ESRD) remains poorly explored. STUDY DESIGN: Longitudinal population-based cohort. SETTING & PARTICIPANTS: Participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study (n=30,239) with information for body mass index (BMI), waist circumference, spot urine albumin-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR; n=26,960). PREDICTOR: Elevated waist circumference or BMI. OUTCOMES & MEASUREMENTS: Incident cases of ESRD were identified through linkage of REGARDS participants with the US Renal Data System. RESULTS: Mean baseline age was 64.8 years, 45.8% were men, and 40.3% were black. Overall, 297 (1.1%) individuals developed ESRD during a median of 6.3 years. After adjustment for all covariates including waist circumference, no significant association was noted between BMI categories and ESRD incidence compared to BMI of 18.5 to 24.9 kg/m2 (referent). Higher waist circumference categories showed significantly increased hazard rates of ESRD, with waist circumference ≥ 108 cm in women and ≥122 cm in men (highest category) showing a 3.97-fold higher hazard rate (95% CI, 2.10-6.86) for ESRD compared to waist circumference < 80 cm in women and <94 cm in men (referent) after adjusting for demographic factors and BMI. However, no significant association was noted between any waist circumference category and ESRD incidence after adjustment for obesity-associated comorbid conditions and baseline ACR and eGFR. LIMITATIONS: Short follow-up period (6.3 years) to assess ESRD risk among adults with eGFRs>60 mL/min/1.73 m2. CONCLUSIONS: In this cohort of older adults, obesity as measured by waist circumference is associated with higher ESRD risk even with adjustment for BMI, whereas obesity as measured by BMI is not associated with higher ESRD risk after adjustment for waist circumference. However, no significant association is noted between increased waist circumference and ESRD risk after adjustment for obesity-related comorbid conditions, eGFR, and ACR. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26187471/Waist_Circumference_Body_Mass_Index_and_ESRD_in_the_REGARDS__Reasons_for_Geographic_and_Racial_Differences_in_Stroke__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)00855-0 DB - PRIME DP - Unbound Medicine ER -