TY - JOUR
T1 - Body mass index and chronic kidney disease outcomes after acute kidney injury
T2 - a prospective matched cohort study
AU - for the ASSESS-AKI Study Investigators
AU - MacLaughlin, Helen L.
AU - Pike, Mindy
AU - Selby, Nicholas M.
AU - Siew, Edward
AU - Chinchilli, Vernon M.
AU - Guide, Andrew
AU - Stewart, Thomas G.
AU - Himmelfarb, Jonathan
AU - Go, Alan S.
AU - Parikh, Chirag R.
AU - Ghahramani, Nasrollah
AU - Kaufman, James
AU - Ikizler, T. Alp
AU - Robinson-Cohen, Cassianne
AU - Kaufman, James S.
AU - Kimmel, Paul L.
AU - Stokes, John B.
AU - Coca, Steven
AU - Garg, Amit
AU - Hsu, Chi yuan
AU - Hsu, Raymond K.
AU - Liu, Kathleen D.
AU - Reeves, W. Brian
AU - Siew, Edward D.
AU - Lewis, Julia B.
AU - Ware, Lorraine
AU - Devarajan, Prasad
AU - Krawczeski, Catherine
AU - Bennett, Michael
AU - Zappitelli, Michael
AU - Wurfel, Mark
N1 - Funding Information:
Dr. Siew has consulted for Akebia, Inc., received honorarium as an invited speaker for the DaVita Annual Physician Conference in 2019, royalties as an author for UptoDate, and serves on the editorial board for CJASN. Dr. Ikizler has consulted for Abbott Renal Care, Fresenius Kabi, Reata and serves as on the editorial board for Kidney International, for which he receives financial compensation. Dr. Ghahramani reported grants from NIH during the conduct of the study. Dr. Go reported grants from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) during the conduct of the study. Dr. Kaufman reported personal fees from NIDDK during the conduct of the study; grant support from Department of Veterans Affairs, Cooperative Studies Program outside the submitted work. Dr. Parikh reported membership on the advisory board of RenalytixAI and owns equity in the same. He also serves as consultant for Genfit and TriCeda.
Funding Information:
HM was funded in part by a UK Renal Association Walls Bursary, and a National Institute of Health Research (NIHR)/Higher Education England (HEE) Clinical Lectureship award (CAT CL-2014-05-005). This paper presents independent research part-funded by the National Institute for Health Research (NIHR) and Health Education England. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Funding Information:
The ASSESS-AKI study is supported by research grants U01-DK082223, U01-DK082185, U01-DK082192 and U01-DK082183 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, U.S. Department of Health and Human Services. Dr. Himmelfarb is also supported by U2CDK114886, UG3TR002158 and U01DK099923. Dr. Siew is also supported by grant 5K23DK088964.
Funding Information:
The ASSESS-AKI Study Investigators are as follows: Vernon M. Chinchilli; Alan S. Go; Jonathan Himmelfarb; T. Alp Ikizler; James S. Kaufman; Paul L. Kimmel; Chirag R. Parikh; and John B. Stokes (in memoriam). Additional collaborators are as follows: Yale: Steven Coca; London, Canada: Amit Garg; Kaiser Permanente Northern California: Sijie Zheng and Leonid Pravoverov; University of California, San Francisco: Chi-yuan Hsu, Raymond K. Hsu and Kathleen D. Liu; Penn State: Nasrollah Ghahramani; University of Texas San Antonio: W. Brian Reeves; Vanderbilt: Edward D. Siew, Julia B. Lewis and Lorraine Ware; Cincinnati: Prasad Devarajan, Catherine Krawczeski, Michael Bennett; Montreal: Michael Zappitelli; Seattle: Mark Wurfel. Institutional Review Boards at University of California, San Francisco; Vanderbilt University; Kaiser Division of Research; Yale University; University Of Washington; Pennsylvania State University at Hershey approved the study.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. Methods: This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size. Results: The cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25–29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20–24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87–3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76–2.92) and similarly, there was no detectable effect of BMI modifying this risk. Conclusions: In this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.
AB - Background: Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. Methods: This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size. Results: The cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25–29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20–24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87–3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76–2.92) and similarly, there was no detectable effect of BMI modifying this risk. Conclusions: In this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.
UR - http://www.scopus.com/inward/record.url?scp=85106970448&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106970448&partnerID=8YFLogxK
U2 - 10.1186/s12882-021-02400-3
DO - 10.1186/s12882-021-02400-3
M3 - Article
C2 - 34049502
AN - SCOPUS:85106970448
VL - 22
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
IS - 1
M1 - 200
ER -