Body-fat indicators and kidney function decline in older post-myocardial infarction patients: The Alpha Omega Cohort Study

Kevin Esmeijer, Johanna M Geleijnse, Erik J Giltay, Theo Stijnen, Friedo W Dekker, Johan W de Fijter, Daan Kromhout, Ellen K Hoogeveen, Kevin Esmeijer, Johanna M Geleijnse, Erik J Giltay, Theo Stijnen, Friedo W Dekker, Johan W de Fijter, Daan Kromhout, Ellen K Hoogeveen

Abstract

Background Obesity increases risk of hypertension and diabetes, the leading causes of end-stage renal disease. The effect of obesity on kidney function decline in stable post-myocardial infarction patients is poorly documented. This relation was investigated in a large cohort of older post-myocardial infarction patients. Design Data were analysed from 2410 post-myocardial infarction patients in the Alpha Omega Trial, aged 60-80 years receiving optimal pharmacotherapy treatment (79% men, 18% diabetes). Methods Cystatin C based estimated glomerular filtration rate (eGFRcysC) was calculated at baseline and after 41 months, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Obesity was defined as body mass index ≥ 30 kg/m2 and high waist circumference as ≥102 and ≥88 cm for men and women. The relation between body mass index, waist circumference and annual eGFRcysC decline was evaluated by linear regression. Results At baseline, mean (standard deviation) eGFRcysC was 81.5 (19.6) ml/min/1.73 m2, 23% of all patients were obese. After multivariable adjustment, the annual mean (95% confidence interval) eGFRcysC decline in men and women was -1.45 (-1.59 to -1.31) and -0.92 (-1.20 to -0.63) ml/min/1.73 m2, respectively ( p = 0.001). Obese versus non-obese patients and patients with high versus normal waist circumference experienced greater annual eGFRcysC decline. Men and women showed an additional annual eGFRcysC decline of -0.35 (-0.56 to -0.14) and -0.21 (-0.55 to 0.14) ml/min/1.73 m2 per 5 kg/m2 body mass index increment ( p for interaction 0.3). Conclusions High compared to normal body mass index or waist circumference were associated with more rapid kidney function decline in older stable post-myocardial infarction patients receiving optimal drug therapy.

Trial registration: ClinicalTrials.gov NCT03192410.

Keywords: Obesity; cardiovascular disease; kidney function; risk factors.

Figures

Figure 1.
Figure 1.
(a) Association between body mass index (BMI) and (b) waist circumference (WC) and annual kidney function decline for men and women. Linear regression coefficients for annual kidney function decline according to BMI or WC were modelled by separate restricted cubic splines. Patients with extreme values of BMI (2 (n = 22, 0.9%) and > 40 kg/m2 (n = 11, 0.5%)), or WC (<70 for women, <80 for men with BMI < 20 kg/m2 (n = 2 and n = 1) and >130 cm (n = 18)) were excluded. The model was adjusted for age, treatment group and current smoking. eGFRcysC: cystatin C based estimated glomerular filtration rate.

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