National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Key Laboratory of Organ Failure Research (Ministry of Education), Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong.
Institute for Biomedicine, Anhui Medical University, Hefei.
J Hypertens. 2018 Oct;36(10):2085-2091. doi: 10.1097/HJH.0000000000001817.
We aimed to investigate the relationship of BMI and waist circumference with the development of chronic kidney disease (CKD).
A total of 12 672 hypertensive patients with estimated glomerular filtration rate (eGFR) at least 60 ml/min per 1.73 m from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was the development of CKD, defined as a decrease in eGFR of at least 30% and to a level of less than 60 ml/min per 1.73 m at the exit visit, or end-stage renal disease. A secondary outcome was rapid renal function decline, defined as an average decline in eGFR of at least 5 ml/min/1.73 m per year.
Over a median follow-up of 4.4 years, the risk of the primary event (per 1 kg/m increment; OR = 1.07, 95% CI 1.02-1.14) or rapid renal function decline (per 1 kg/m increment; OR = 1.05, 95% CI 1.01-1.08) increased with each increment of BMI. Consistently, compared with those with normal weight (BMI <24.0 kg/m), participants with obesity (BMI ≥28.0 kg/m) had an increased risk of the primary event (OR = 1.82; 95% CI 1.15-2.90) and rapid renal function decline (OR = 1.26; 95% CI 0.95-1.67). However, waist circumference had no obvious effect on the risk of the primary event (per 5 cm increment: OR = 0.94, 95% CI 0.85-1.04) or rapid renal function decline (OR = 0.96, 95% CI 0.90-1.03).
Higher BMI, but not waist circumference, was significantly associated with an increased risk of CKD development in hypertensive patients with normal kidney function.
本研究旨在探讨体重指数（BMI）和腰围与慢性肾脏病（CKD）发生发展的关系。
本研究纳入了中国脑卒中一级预防研究（CSPPT）肾脏亚研究中至少有肾小球滤过率（eGFR）为 60ml/min/1.73m2的 12672 例高血压患者。主要结局为 CKD 的发生，定义为 eGFR 至少下降 30%，至出口访视时 eGFR 水平＜60ml/min/1.73m2，或终末期肾病。次要结局为肾功能快速下降，定义为 eGFR 每年平均下降≥5ml/min/1.73m2。
在中位随访 4.4 年后，每增加 1kg/m2，主要事件（每增加 1kg/m2，OR=1.07，95%CI 1.02-1.14）或肾功能快速下降（每增加 1kg/m2，OR=1.05，95%CI 1.01-1.08）的风险均增加。同样，与体重正常（BMI＜24.0kg/m2）的患者相比，肥胖（BMI≥28.0kg/m2）患者发生主要事件（OR=1.82，95%CI 1.15-2.90）和肾功能快速下降（OR=1.26，95%CI 0.95-1.67）的风险增加。然而，腰围对主要事件（每增加 5cm，OR=0.94，95%CI 0.85-1.04）或肾功能快速下降（OR=0.96，95%CI 0.90-1.03）的风险无明显影响。
在肾功能正常的高血压患者中，较高的 BMI 与 CKD 发生风险增加显著相关，而腰围则不然。
