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Body mass index, coronary artery calcification, and kidney function decline in stage 3 to 5 chronic kidney disease
Jocelyn S Garland1, Rachel M Holden, Wilma M Hopman
1Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada. garlandj@queensu.ca
Insights
Higher body mass index (BMI) and coronary artery calcification (CAC) predict kidney function decline in chronic kidney disease (CKD) patients. Increased CAC burden significantly elevates the risk of declining kidney function over one year.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Chronic kidney disease (CKD) affects millions globally, with progression to end-stage renal disease posing significant health and economic burdens.
- Identifying modifiable risk factors for CKD progression is crucial for effective patient management and intervention.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and coronary artery calcification (CAC) as predictors of kidney function decline in predialysis CKD patients.
- To assess the impact of baseline BMI and CAC levels on the rate of estimated glomerular filtration rate (eGFR) decline over a one-year period.
Main Methods:
- A prospective cohort study included 125 patients with stage 3 to 5 predialysis CKD.
- Baseline measurements included BMI, CAC (assessed via multislice computed tomography), and kidney function (eGFR).
- Kidney function decline was defined as a ≥ 5% decrease in eGFR over one year.
Main Results:
- Patients experiencing a ≥ 5% eGFR decline exhibited significantly higher baseline BMI and median CAC scores compared to those without decline.
- Both BMI and CAC scores demonstrated a positive correlation with the risk of eGFR decline.
- Logistic regression analyses indicated that increasing CAC burden was independently associated with an elevated risk of kidney function decline.
Conclusions:
- Coronary artery calcification and elevated BMI are significant risk factors associated with kidney function decline in predialysis CKD patients.
- The risk of kidney function deterioration escalates with a greater burden of CAC, even after adjusting for other CKD progression risk factors.
- Further research is warranted to validate these findings and explore therapeutic strategies targeting obesity and CAC to mitigate kidney function loss.
Objective:
To determine whether body mass index (BMI) and coronary artery calcification (CAC) are risk factors for kidney function decline in predialysis chronic kidney disease (CKD) patients.
Design:
Prospective cohort study of 125 stage 3 to 5 predialysis CKD patients.
Subjects And Setting:
CKD patients receiving care in Kingston, Ontario, Canada.
Methods:
BMI, CAC, and kidney function were measured at baseline. CAC was measured by multislice computed tomography scan. Kidney function was determined by the 4-variable reexpressed Modification of Diet in Renal Disease Study equation. At study end, kidney function decline among patients was compared according to baseline BMI and CAC.
Main Outcome:
Kidney function decline was defined as a 1-year decline in estimated glomerular filtration rate (eGFR) of ≥ 5%.
Results:
Individuals with a decline in eGFR of ≥ 5% at 1 year had higher baseline BMI (33.5 ± 8.3 vs. 28.4 ± 4.9 kg/m(2); P = .0001) and higher baseline median CAC scores (239 vs. 25 Agatston units; P = .01) compared with subjects without such a decline. BMI (r = 0.35; P < .0001) and logarithmically transformed CAC score (r = 0.22; P = .01) correlated with an eGFR decline of ≥ 5%. Both crude and adjusted logistic regression analyses showed escalating CAC (with CAC reported in quintiles and CAC score = 0 Agatston unit as the reference group) was associated with an increased risk of eGFR decline of ≥ 5%.
Conclusions:
CAC and BMI were associated with kidney function decline over 1 year. The risk of kidney function decline was greater in those with increasing burden of CAC, which remained robust in the adjusted analysis accounting for the risk factors for CKD progression. Larger studies will be required for independent validation of the associations of BMI, CAC, and kidney function decline, and to investigate whether obesity and CAC treatment strategies are efficacious in attenuating kidney function decline in predialysis CKD patients.
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