Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies

• Type of Material: Article
• Authors: Chia-shi Wang, Emory University; Paras P Shah, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Tammy M Brady, Johns Hopkins University; Kevin EC Meyers, Children Hosp; Michelle M O'Shaughnessy, University College Cork; Keisha L Gibson, University of North Carolina; Tarak Srivastava, Children’s Mercy Hospital, Kansas City; Jarcy Zee, Arbor Research Collaborative for Health; Daniel Cattran, Toronto General Research Institute; Katherine R Tuttle, University of Washington; Crystal Gadegbeku, Temple University; Dorey Glenn, University of North Carolina; Vimal Derebail, University of North Carolina; A Smith, Arbor Research Collaborative for Health; Brenda W Gillespie, University of Michigan; Markus Bitzer, University of Michigan; Christine B Sethna, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
• Language: English
• Date: 2021-03-05
• Publisher: KARGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021, Silverchair Publisher
• Final Published Version (URL): http://dx.doi.org/10.1159/000513869
• Title of Journal or Parent Work: NEPHRON
• Volume: 145
• Issue: 3
• Start Page: 245
• End Page: 255
• Grant/Funding Information: The Nephrotic Syndrome Study Network Consortium (NEPTUNE), U54-DK-083912, is a part of the National Institutes of Health (NIH) Rare Disease Clinical Research Network (RDCRN), supported through a collaboration between the Office of Rare Diseases Research (ORDR), NCATS, and the National Institute of Diabetes, Digestive, and Kidney Diseases. Additional funding and/or programmatic support for this project has also been provided by the University of Michigan, the NephCure Kidney International and the Halpin Foundation. This work was also supported by the American Heart Association Grant in Aid 15GRNT25360029 (Sethna).
• Keywords: Life Sciences & Biomedicine; Urology & Nephrology; Proteinuria; Science & Technology; Body mass index; Pediatrics; Hypertension; Obesity; Nephrotic syndrome

Abstract

Background/Aims: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. Methods: In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots. Results: The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001). Conclusion: Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.