GFR, Body Mass Index, and Low High-Density Lipoprotein Concentration in Adults With and Without CKD

Lo, Joan C.; Go, Alan S.; Chandra, Malini; Fan, Dongjie; Kaysen, George A.

doi:10.1053/j.ajkd.2007.07.011

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 4 , Pages 552-558, October 2007

GFR, Body Mass Index, and Low High-Density Lipoprotein Concentration in Adults With and Without CKD

Joan C. Lo, MD
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Medicine, University of California San Francisco, San Francisco
- Address correspondence to Joan C. Lo, MD, Division of Research, Kaiser Permanente of Northern California, 2000 Broadway St, Oakland, CA 94612.
Alan S. Go, MD
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Medicine, University of California San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
Malini Chandra, MS
- Division of Research, Kaiser Permanente Northern California, Oakland
Dongjie Fan, MSPH
- Division of Research, Kaiser Permanente Northern California, Oakland
George A. Kaysen, MD, PhD
- Department of Medicine, University of California Davis, Davis
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis
- Department of Veterans Affairs Northern California Health Care System, Mather, CA.

Received 3 January 2007; accepted 5 July 2007. published online 06 September 2007.

Background

Low high-density lipoprotein (HDL) cholesterol level is common in patients with chronic kidney disease, but associations between severity of chronic kidney disease, obesity, and HDL level have not been well defined.

Study Design

Cross-sectional study.

Setting & Participants

Within a large integrated health care delivery system, we identified all adult individuals without diabetes who had measured kidney function (estimated glomerular filtration rate [eGFR]), body mass index (BMI), and HDL level, but no substantial proteinuria, confounding medications, or prior renal replacement therapy.

Predictors

The primary predictors for our analyses were eGFR and BMI.

Outcomes

Low HDL cholesterol level was the outcome. We performed multivariable logistic regression to investigate whether the relationship between BMI and low HDL level (men, <40 mg/dL; women, <50 mg/dL) varied as a function of eGFR.

Results

Of 380,207 individuals who met cohort entry criteria, there were 26,089 (7%) with chronic kidney disease by eGFR level. Compared with eGFR of 60 mL/min/1.73 m² or greater, lower eGFR category (in mL/min/1.73 m²) was associated with an increased adjusted odds of low HDL level independent of BMI and other confounders. However, there was a significant interaction between eGFR and BMI (P < 0.001). In separate models stratified by eGFR category (≥60, 45 to 59, and 30 to 44 mL/min/1.73 m²), greater BMI was associated with a graded increased adjusted odds of low HDL level in each eGFR category, but this relationship was attenuated in patients with lower eGFR.

Limitations

Information for undiagnosed diabetes and proteinuria was unavailable.

Conclusions

Decreased eGFR is independently associated with greater odds of having a low HDL level. Across a spectrum of eGFR, greater BMI was associated with lower HDL level, but the magnitude of this association was diminished at lower eGFR, suggesting that other factors may also contribute to low HDL levels in patients with advanced chronic kidney disease.

Index Words: Chronic kidney disease, dyslipidemia, obesity, high-density lipoprotein (HDL) cholesterol