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BMJ. 2019 Jan 10;364:k5301. doi: 10.1136/bmj.k5301.

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium.

Collaborators (178)

Astor B, Appel L, Greene T, Chen T, Chalmers J, Arima H, Perkovic V, Yatsuya H, Tamakoshi K, Hirakawa Y, Coresh J, Sang Y, Polkinghorne K, Chadban S, Atkins R, Levin A, Djurdjev O, Klein R, Lee K, Liu L, Zhao M, Wang F, Wang J, Tang M, Heine G, Emrich I, Zawada A, Bauer L, Nally J, Schold J, Shlipak M, Sarnak M, Katz R, Hiramoto J, Iso H, Yamagishi K, Umesawa M, Muraki I, Fukagawa M, Maruyama S, Hamano T, Hasegawa T, Fujii N, Jafar T, Hatcher J, Poulter N, Chaturvedi N, Wheeler D, Emberson J, Townend J, Landray M, Brenner H, Schöttker B, Saum KU, Rothenbacher D, Fox C, Hwang SJ, Köttgen A, Schneider MP, Eckardt KU, Green J, Kirchner HL, Ito S, Miyazaki M, Nakayama M, Yamada G, Cirillo M, Romundstad S, Øvrehus M, Langlo KA, Irie F, Sairenchi T, Rebholz CM, Young B, Boulware LE, Ishikawa S, Yano Y, Kotani K, Nakamura T, Jee SH, Kimm H, Mok Y, Chodick G, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Bots M, Sarnak M, Inker L, Peralta C, Kollerits B, Ritz E, Nitsch D, Fletcher A, Bottinger E, Nadkarni GN, Ellis SB, Nadukuru R, Fernandez E, Betriu A, Bermudez-Lopez M, Stengel B, Metzger M, Flamant M, Houillier P, Haymann JP, Froissart M, Ueshima H, Okayama A, Tanaka S, Okamura T, Elley CR, Collins JF, Drury PL, Ohkubo T, Asayama K, Metoki H, Kikuya M, Nakayama M, Iseki C, Nelson RG, Knowler WC, Bakker SJL, Heerspink HJL, Brunskill N, Major R, Shepherd D, Medcalf J, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Kovesdy C, Kalantar-Zadeh K, Sumida K, Muntner P, Warnock D, Judd S, Panwar B, de Zeeuw D, Brenner B, Sedaghat S, Ikram MA, Hoorn EJ, Dehghan A, Wong TY, Sabanayagam C, Cheng CY, Banu R, Segelmark M, Stendahl M, Schön S, Tangri N, Sud M, Naimark D, Wen CP, Tsao CK, Tsai MK, Chen CH, Konta T, Hirayama A, Ichikawa K, Hadaegh F, Mirbolouk M, Azizi F, Solbu MD, Jenssen TG, Eriksen BO, Eggen AE, Lannfelt L, Larsson A, Ärnlöv J, Landman GWD, van Hateren KJJ, Kleefstra N, Chen J, Kwak L, Surapaneni A.

Author information

Kidney Health Research Institute, and Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Diabetes Centre, Isala, and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden and Swedish Renal Registry, Jönköping, Sweden.
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Dialysis Unit, University of the Ryukyus Hospital, Nishihara, Japan.
Yuuaikai Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan.
Departments of Medicine and General Practice & Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand.
Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
Kaiser Permanente, Hawaii Region, Moanalua Medical Center, Honolulu, HI, USA.
Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan.
Department of Public Health, Shiga University of Medical Science, Otsu, Japan.
Section of Nephrology, Baylor College of Medicine, Houston, TX, USA.
Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Vascular and Renal Translational Research Group, REDinREN del ISCIII, IRBLleida, Lleida, Spain.
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
Peking University Institute of Nephrology, Division of Nephrology, Peking University First Hospital, Beijing, China.
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim, Norway.
Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway.
Division of Nephrology at Tufts Medical Center, Boston, MA, USA.
Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
George Institute for Global Health, University of Oxford, Oxford, UK.
George Institute for Global Health, University of New South Wales, Sydney, Australia.



To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.


Individual participant data meta-analysis.


Cohorts from 40 countries with data collected between 1970 and 2017.


Adults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).


GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m2) and all cause mortality.


Over a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.


Elevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: part support from the US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases for the submitted work; ARC was supported by the NIDDK; no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activites that could appear to have influenced the submitted work.

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