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Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012.
Am J Kidney Dis. 2016 09; 68(3):414-21.AJ

Abstract

BACKGROUND

Prevalence and factors associated with obstructive and restrictive lung function in people with chronic kidney disease (CKD) are unknown.

STUDY DESIGN

Cross-sectional and longitudinal analyses.

SETTING & PARTICIPANTS

Participants aged 40 to 79 years from NHANES (National Health and Nutrition Examination Survey) 2007 to 2012 who underwent spirometry testing.

PREDICTOR

CKD (estimated glomerular filtration rate [eGFR] >15-<60mL/min/1.73m(2) or urinary albumin-creatinine ratio ≥ 30mg/g).

OUTCOMES

Restrictive lung function (defined as FEV1/FVC≥0.70 and baseline FVC<80% predicted), obstructive lung function (defined as FEV1/FVC<0.70 based on postbronchodilator spirometric results), and mortality data (available for 2007-2008 and 2009-2010 survey periods).

RESULTS

7,610 participants (CKD=1,338; non-CKD=6,272) were included. Prevalences of obstructive lung function adjusted to the mean age of 55 years and 50% men in the CKD and non-CKD groups were 15.6% and 13.3%, respectively (P=0.2). Similarly, adjusted prevalences of restrictive lung function in the CKD and non-CKD groups were 9.8% and 6.7%, respectively (P=0.01). Presence of albumin-creatinine ratio ≥ 30mg/g was associated with obstructive (OR, 1.42; 95% CI, 1.07-1.88) and restrictive lung function (OR, 1.43; 95% CI, 1.01-2.03) in the entire study cohort. eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. In a multivariable Cox model, age (HR, 1.07; 95% CI, 1.04-1.11) and presence of obstructive lung function (HR, 2.68; 95% CI, 1.80-3.97), but not CKD measures, were associated with death.

LIMITATIONS

Small proportion of participants with advanced kidney disease.

CONCLUSIONS

In a representative sample of US adults, impaired lung function is common in those with and without CKD. Albuminuria was independently associated with both obstructive and restrictive lung function, and eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. Older age and obstructive lung function were associated with higher likelihood of death. Further studies examining the burden of lung disease in advanced CKD are needed.

Authors+Show Affiliations

Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address: sankar.navaneethan@bcm.edu.Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.Department of Nephrology, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.

Pub Type(s)

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

Language

eng

PubMed ID

27130720

Citation

Navaneethan, Sankar D., et al. "Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 3, 2016, pp. 414-21.
Navaneethan SD, Mandayam S, Arrigain S, et al. Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012. Am J Kidney Dis. 2016;68(3):414-21.
Navaneethan, S. D., Mandayam, S., Arrigain, S., Rahman, M., Winkelmayer, W. C., & Schold, J. D. (2016). Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(3), 414-21. https://doi.org/10.1053/j.ajkd.2016.03.415
Navaneethan SD, et al. Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012. Am J Kidney Dis. 2016;68(3):414-21. PubMed PMID: 27130720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstructive and Restrictive Lung Function Measures and CKD: National Health and Nutrition Examination Survey (NHANES) 2007-2012. AU - Navaneethan,Sankar D, AU - Mandayam,Sreedhar, AU - Arrigain,Susana, AU - Rahman,Mahboob, AU - Winkelmayer,Wolfgang C, AU - Schold,Jesse D, Y1 - 2016/04/27/ PY - 2015/12/12/received PY - 2016/03/11/accepted PY - 2016/5/1/entrez PY - 2016/5/1/pubmed PY - 2017/6/1/medline KW - Lung disease KW - National Health and Nutrition Examination Survey (NHANES) KW - albuminuria KW - chronic kidney disease (CKD) KW - estimated glomerular filtration rate (eGFR) KW - lower respiratory disease KW - mortality KW - obstructive lung function KW - renal function KW - restrictive lung function KW - spirometry KW - urine albumin-creatinine ratio (UACR) SP - 414 EP - 21 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 3 N2 - BACKGROUND: Prevalence and factors associated with obstructive and restrictive lung function in people with chronic kidney disease (CKD) are unknown. STUDY DESIGN: Cross-sectional and longitudinal analyses. SETTING & PARTICIPANTS: Participants aged 40 to 79 years from NHANES (National Health and Nutrition Examination Survey) 2007 to 2012 who underwent spirometry testing. PREDICTOR: CKD (estimated glomerular filtration rate [eGFR] >15-<60mL/min/1.73m(2) or urinary albumin-creatinine ratio ≥ 30mg/g). OUTCOMES: Restrictive lung function (defined as FEV1/FVC≥0.70 and baseline FVC<80% predicted), obstructive lung function (defined as FEV1/FVC<0.70 based on postbronchodilator spirometric results), and mortality data (available for 2007-2008 and 2009-2010 survey periods). RESULTS: 7,610 participants (CKD=1,338; non-CKD=6,272) were included. Prevalences of obstructive lung function adjusted to the mean age of 55 years and 50% men in the CKD and non-CKD groups were 15.6% and 13.3%, respectively (P=0.2). Similarly, adjusted prevalences of restrictive lung function in the CKD and non-CKD groups were 9.8% and 6.7%, respectively (P=0.01). Presence of albumin-creatinine ratio ≥ 30mg/g was associated with obstructive (OR, 1.42; 95% CI, 1.07-1.88) and restrictive lung function (OR, 1.43; 95% CI, 1.01-2.03) in the entire study cohort. eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. In a multivariable Cox model, age (HR, 1.07; 95% CI, 1.04-1.11) and presence of obstructive lung function (HR, 2.68; 95% CI, 1.80-3.97), but not CKD measures, were associated with death. LIMITATIONS: Small proportion of participants with advanced kidney disease. CONCLUSIONS: In a representative sample of US adults, impaired lung function is common in those with and without CKD. Albuminuria was independently associated with both obstructive and restrictive lung function, and eGFR<60mL/min/1.73m(2) was associated with higher odds of obstructive lung function. Older age and obstructive lung function were associated with higher likelihood of death. Further studies examining the burden of lung disease in advanced CKD are needed. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/27130720/Obstructive_and_Restrictive_Lung_Function_Measures_and_CKD:_National_Health_and_Nutrition_Examination_Survey__NHANES__2007_2012_ DB - PRIME DP - Unbound Medicine ER -