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Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study.
Am J Kidney Dis 2017; 70(5):675-685AJ

Abstract

BACKGROUND

Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD).

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012.

PREDICTORS

Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry.

OUTCOMES

Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome.

RESULTS

During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD.

LIMITATIONS

Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline.

CONCLUSIONS

Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN; Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: kmatsush@jhsph.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28754455

Citation

Sumida, Keiichi, et al. "Lung Function and Incident Kidney Disease: the Atherosclerosis Risk in Communities (ARIC) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 70, no. 5, 2017, pp. 675-685.
Sumida K, Kwak L, Grams ME, et al. Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2017;70(5):675-685.
Sumida, K., Kwak, L., Grams, M. E., Yamagata, K., Punjabi, N. M., Kovesdy, C. P., ... Matsushita, K. (2017). Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 70(5), pp. 675-685. doi:10.1053/j.ajkd.2017.05.021.
Sumida K, et al. Lung Function and Incident Kidney Disease: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2017;70(5):675-685. PubMed PMID: 28754455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study. AU - Sumida,Keiichi, AU - Kwak,Lucia, AU - Grams,Morgan E, AU - Yamagata,Kunihiro, AU - Punjabi,Naresh M, AU - Kovesdy,Csaba P, AU - Coresh,Josef, AU - Matsushita,Kunihiro, Y1 - 2017/07/26/ PY - 2016/12/22/received PY - 2017/05/22/accepted PY - 2017/7/30/pubmed PY - 2017/10/31/medline PY - 2017/7/30/entrez KW - Atherosclerosis Risk in Communities (ARIC) Study KW - Lung function KW - chronic kidney disease (CKD) KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - obstructive lung function KW - restrictive lung function KW - spirometry SP - 675 EP - 685 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 70 IS - 5 N2 - BACKGROUND: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. PREDICTORS: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. OUTCOMES: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. RESULTS: During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. LIMITATIONS: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. CONCLUSIONS: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/28754455/Lung_Function_and_Incident_Kidney_Disease:_The_Atherosclerosis_Risk_in_Communities__ARIC__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(17)30784-9 DB - PRIME DP - Unbound Medicine ER -