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.
Limitations
Although patients with ESRD at baseline were excluded, information for chronic kidney disease at the baseline examination was not available.
Conclusion
Strategies aimed at preventing the development of ESRD should incorporate measures to maintain a normal body weight.
1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
2Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
3Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China
4Department of Medicine, Tulane University School of 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, MS, Division of Population Genetics and Prevention, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Rd, Beijing 100037, China.
ABSTRACT