de Boer Ian H, Katz Ronit, Fried Linda F, Ix Joachim H, Luchsinger Jose, Sarnak Mark J, Shlipak Michael G, Siscovick David S, Kestenbaum Bryan
Division of Nephrology, University of Washington, Seattle, WA 98195, USA.
Am J Kidney Dis. 2009 Dec;54(6):1043-51. doi: 10.1053/j.ajkd.2009.07.018. Epub 2009 Sep 25.
The prevalence of chronic kidney disease is growing most rapidly among older adults; however, determinants of impaired kidney function in this population are not well understood. Obesity assessed in midlife has been associated with chronic kidney disease.
Cohort study.
SETTING & PARTICIPANTS: 4,295 participants in the community-based Cardiovascular Health Study, aged >or= 65 years.
Body mass index, waist circumference, and fat mass measured using bioelectrical impedance.
Change in glomerular filtration rate (GFR) during 7 years of follow-up.
Longitudinal estimates of GFR calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation.
Estimated GFR decreased by an average of 0.4 +/- 3.6 mL/min/1.73 m(2)/y, and rapid GFR loss (>3 mL/min/1.73 m(2)/y) occurred in 693 participants (16%). Baseline body mass index, waist circumference, and fat mass were each associated with increased risk of rapid GFR loss: ORs, 1.19 (95% CI, 1.09-1.30) per 5 kg/m(2), 1.25 (95% CI, 1.16-1.36) per 12 cm, and 1.14 (95% CI, 1.05-1.24) per 10 kg after adjustment for age, sex, race, and smoking. The magnitude of increased risk was larger for participants with estimated GFR < 60 mL/min/1.73 m(2) at baseline (P for interaction < 0.05). Associations were substantially attenuated by further adjustment for diabetes, hypertension, and C-reactive protein level. Obesity measurements were not associated with change in GFR estimated using serum cystatin C level.
Few participants with advanced chronic kidney disease at baseline, no direct GFR measurements.
Obesity may be a modifiable risk factor for the development and progression of kidney disease in older adults.
慢性肾脏病的患病率在老年人中增长最为迅速；然而，该人群肾功能受损的决定因素尚未完全明确。中年时评估的肥胖与慢性肾脏病有关。
队列研究。
社区心血管健康研究中的4295名参与者，年龄≥65岁。
使用生物电阻抗测量的体重指数、腰围和脂肪量。
随访7年期间肾小球滤过率（GFR）的变化。
使用4变量肾病饮食改良（MDRD）研究方程计算GFR的纵向估计值。
估计GFR平均每年下降0.4±3.6 mL/min/1.73 m²，693名参与者（16%）出现快速GFR下降（>3 mL/min/1.73 m²/年）。基线体重指数、腰围和脂肪量均与快速GFR下降风险增加相关：校正年龄、性别、种族和吸烟后，每5 kg/m²的OR为1.19（95%CI，1.09 - 1.30），每12 cm的OR为1.25（95%CI，1.16 - 1.36），每10 kg的OR为1.14（95%CI，1.05 - 1.24）。对于基线时估计GFR<60 mL/min/1.73 m²的参与者，风险增加幅度更大（交互作用P<0.05）。进一步校正糖尿病、高血压和C反应蛋白水平后，相关性显著减弱。肥胖测量值与使用血清胱抑素C水平估计的GFR变化无关。
基线时患有晚期慢性肾脏病的参与者较少，未进行直接GFR测量。
肥胖可能是老年人肾病发生和进展的一个可改变的危险因素。
