Lifestyle Factors, Obesity and the Risk of Chronic Kidney Disease

Stengel, Bénédicte; Tarver-Carr, Michelle E; Powe, Neil R.; Eberhardt, Mark S.; Brancati, Frederick L.

doi:10.1097/01.ede.0000071413.55296.c4

Cited by 304 publications

(206 citation statements)

References 30 publications

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“…In a crosssectional analysis of data from the National Health and Nutrition Examination Survey, only morbid obesity (defined as BMI Ն35 Kg/m 2 ) was related to CKD, 22 whereas only three individuals had BMI of Ն35 kg/m 2 in our study. Another possibility is that the 4.1-yr follow-up period in this study may have been insufficient to establish any relationship between these factors.…”

Section: ͻ0001mentioning

confidence: 54%

Changes in Body Weight Predict CKD in Healthy Men

Ryu¹,

Chang²,

Woo³

et al. 2008

Journal of the American Society of Nephrology

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Several recent prospective studies have reported that obesity is associated with an increased risk for chronic kidney disease (CKD), but it is unknown whether weight gain increases the risk for CKD if one remains within the "normal" category of body mass index (BMI). We prospectively followed a cohort of 8792 healthy men who had no known risk factors for CKD and participated in a comprehensive health evaluation program at a large worksite. During 35,927 person-years of follow-up, 427 new incident cases of CKD (estimated GFR Ͻ64 ml/min per 1.73 m 2 ) developed. Cox proportional hazards modeling revealed that in both the normal-weight and overweight groups, a U-shaped association between weight change categories and development of CKD was observed after adjustment for age, baseline GFR, baseline BMI, HDL, fasting blood glucose, uric acid, and exercise habits. The lowest risk for CKD was observed among those whose weight changed Ϫ0.25 to Ͻ0.25 kg/yr (P Ͻ 0.001 for quadratic term). Weight change as a time-dependent variable was significantly related to CKD incidence. These relationships remained significant even after further adjustment for Homeostasis Model Assessment of Insulin Resistance, high-sensitivity C-reactive protein, systolic BP, diastolic BP, metabolic syndrome, incident hypertension, or incident diabetes. In summary, increases in body weight are independently associated with an increased risk for CKD, even when the BMI remains within the normal range.

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Section: ͻ0001mentioning

confidence: 54%

Changes in Body Weight Predict CKD in Healthy Men

Ryu¹,

Chang²,

Woo³

et al. 2008

Journal of the American Society of Nephrology

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“…Large studies have shown that achieving a hemoglobin A1c level#7% reduces proteinuria and the risk of CKD (33,34). Limited evidence exists for smoking cessation (35), lipid control (36), and the avoidance of nephrotoxic agents (37). However, lipid control and smoking cessation seem prudent in light of the high incidence of cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a CKD Checklist for Primary Care Providers

Mendu

Schneider

Aizer³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives CKD is associated with significant morbidity, mortality, and financial burden. Practice guidelines outlining CKD management exist, but there is limited application of these guidelines. Interventions to improve CKD guideline adherence have been limited. This study evaluated a new CKD checklist (a tool outlining management guidelines for CKD) to determine whether implementation in an academic primary care clinic improved adherence to guidelines.Design, setting, participants, & measurements During a 1-year period (August 2012-August 2013), a prospective study was conducted among 13 primary care providers (PCPs), four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD stages 1-4. All providers received education regarding CKD guidelines. The intervention and control groups consisted of 105 and 263 patients, respectively. Adherence to CKD management guidelines was measured.Results A random-effects logistic regression analysis was performed to account for intra-group correlation by PCP assignment and adjusted for age and CKD stage. CKD care improved among patients whose PCPs were assigned to the checklist intervention compared with controls. Patients in the CKD checklist group were more likely than controls to have appropriate annual laboratory testing for albuminuria (odds ratio [OR], 7.9; 95% confidence interval [95% CI], 3.6 to 17.2), phosphate (OR, 3.5; 95% CI, 1.5 to 8.3), and parathyroid hormone (OR, 8.1; 95% CI, 4.8 to 13.7) (P,0.001 in all cases). Patients in the CKD checklist group had higher rates of achieving a hemoglobin A1c target,7% (OR, 2.7; 95% CI, 1.4 to 5.1), use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker (OR, 2.1; 95% CI, 1.0 to 4.2), documentation of avoidance of nonsteroidal anti-inflammatory drugs (OR, 41.7; 95% CI, 17.8 to 100.0), and vaccination for annual influenza (OR, 2.1; 95% CI, 1.1 to 4.0) and pneumococcus (OR, 4.7; 95% CI, 2.6 to 8.6) (P,0.001 in all cases).Conclusions Implementation of a CKD checklist significantly improved adherence to CKD management guidelines and delivery of CKD care.

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“…A systematic meta-analysis based primarily on community-based cohort studies [6][7][8][9][10] (shown in Table 1) confirmed the effect of smoking on CKD development. 11 The increased risk of developing CKD among smokers vs. non-smokers was reported to be associated with smoking 420 cigarettes per day (odds ratio, 1.51; 95% CI, 1.06-2.15), male (odds ratio, 2.4; 95% CI, 1.2-4.5) and smoking for over 40 years (odds ratio, 2.3; 95% CI, 1.2-4.3).…”

Section: Smoking and Ckd In The General Populationmentioning

confidence: 91%

Cigarette smoking and chronic kidney diseases

et al. 2011

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Observational studies have suggested that different chronic kidney diseases (CKDs) have differing relationships to smoking, but no randomized controlled trial has been conducted to examine this topic. In this article, we review available evidence concerning the relationship between smoking and each type of CKD in the general population as well as in patients with diabetes mellitus (DM), hypertension (HT), primary glomerulonephritis and kidney transplants. There is good evidence of a relationship between smoking and CKD in patients with IgA nephropathy and kidney transplant recipients, but not in patients with DM or HT. Interestingly, it has been reported that the effect of smoking on CKD progression varies depending on the CKD stage. This variation might indicate a cumulative effect of smoking, possibly through oxidative stress. A better understanding of the relationship between smoking and CKD would be useful for nephrologists.

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Lifestyle Factors, Obesity and the Risk of Chronic Kidney Disease

Abstract: These data suggest that physical inactivity, smoking and morbid obesity contribute to the risk of chronic kidney disease.

Cited by 304 publications

References 30 publications

Changes in Body Weight Predict CKD in Healthy Men

Changes in Body Weight Predict CKD in Healthy Men

Implementation of a CKD Checklist for Primary Care Providers

Cigarette smoking and chronic kidney diseases

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