Body Mass Index and Risk of ESRD in China

Reynolds, Kristi; Gu, Dongfeng; Muntner, Paul; Chen, Jing; Wu, Xigui; Yau, C. Lillian; Duan, Xiufang; Chen, Chung-Shiuan; Hamm, L. Lee; He, Jiang

doi:10.1053/j.ajkd.2007.08.011

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 754-764, November 2007

Body Mass Index and Risk of ESRD in China

Kristi Reynolds, PhD, MPH
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Address correspondence to Kristi Reynolds, PhD, MPH, Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 2nd Floor, Pasadena, CA 91101.
Dongfeng Gu, MD, MSc
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China
- Dongfeng Gu, MD, MS, Division of Population Genetics and Prevention, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Rd, Beijing 100037, China.
Paul Muntner, PhD, MHS
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
Jing Chen, MD, MSc
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
Xigui Wu, MD
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China
C. Lillian Yau, PhD
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Xiufang Duan, MD
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China
Chung-Shiuan Chen, MS
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
L. Lee Hamm, MD
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
Jiang He, MD, PhD
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA.

Received 23 April 2007; accepted 21 August 2007.

Background

The relationship between body mass index (BMI) and risk of end-stage renal disease (ESRD) in Asians has not been well established.

Study Design

Prospective cohort study.

Setting & Participants

143,802 men and women 40 years and older in China.

Predictor

Body weight, height, and covariables were obtained at a baseline examination in 1991 by following a standardized protocol. BMI was calculated as weight in kilograms divided by the square of height in meters.

Outcomes

Time to onset of ESRD, ascertained in 1999 to 2000 from medical records, death certificates, and interviews with participants or their proxies.

Results

During 1,112,667 person-years of follow-up, 350 participants initiated renal replacement therapy or died of renal failure. After adjustment for age, sex, geographic region (north versus south China), urbanization (urban versus rural residence), education, physical activity, cigarette smoking, and alcohol consumption, a J-shaped association between BMI and all-cause ESRD was observed. Compared with those with normal body weight (BMI, 18.5 to 24.9 kg/m²), multivariate-adjusted relative risks for all-cause ESRD for underweight (BMI < 18.5 kg/m²), overweight (BMI, 25.0 to 29.9 kg/m²), and obese subjects (BMI ≥ 30 kg/m²) were 1.39 (95% confidence interval [CI], 1.02 to 1.91), 1.21 (95% CI, 0.92 to 1.59), and 2.14 (95% CI, 1.39 to 3.29), respectively. The J-shaped association existed even after additional adjustment for systolic blood pressure and history of diabetes and cardiovascular disease.