Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Adiposity and Risk of Decline in GFR

BMJ; ePub 2019 Jan 10; Chang, Grams, et al

Among individuals who have normal or reduced levels of glomerular filtration rate (GFR), elevated body mass index (BMI), waist circumference, and waist-to-height ration are independent factors for GFR decline and mortality. This according to a meta-analysis of 39 general population cohorts (n=5,459,014), of which 21 (n=594,496) had data on waist circumference; 6 cohorts with high cardiovascular (CV) risk (n=84,417); and 18 cohorts with chronic kidney disease (CKD) (n=91,607). The included cohorts were from 40 countries with data collected between 1970 and 2017. The primary outcomes were GFR decline and all-cause mortality. Researchers found:

  • Over a median follow-up of 8 years, 246,607 (5.6%) individuals in the general population cohorts had GFR decline, and 782,329 (14.7%) died.
  • BMI >25 was associated with increased risk of GFR decline during follow-up.
  • In the general population, body mass indices of 30, 35, and 40 were associated with 18%, 69%, and 102% increased risk of GFR decline, respectively, compared with BMI of 25.
  • The association between elevated BMI and GFR decline risk was qualitatively similar in subgroups by age, sex, race, level of GFR, hypertension, and diabetes status.


Chang AR, Grams ME, Ballew SH, et al. Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium. [Published online ahead of print January 10, 2019]. BMJ. doi:10.1136/bmj.k5301.