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Obesity and Risk for Chronic Renal Failure

Elisabeth Ejerblad^*, C. Michael Fored, Per Lindblad^*,, Jon Fryzek^,||, Joseph K. McLaughlin^,|| and Olof Nyrén^*,||

^* Department of Medical Epidemiology and Biostatistic; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital M9:01, Stockholm, Sweden; Department of Urology, Sundsvall Hospital, Sundsvall, Sweden; The International Epidemiology Institute, Rockville, Maryland; and ^|| Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

Address correspondence to: Dr. Elisabeth Ejerblad, Department of Hematology, OTM, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Phone: +46-18-611-00-00; Fax: +46-18-50-29-16; elisabeth.ejerblad{at}meb.ki.se

Received for publication June 20, 2005. Accepted for publication March 15, 2006.

Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF). This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF. Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women) during the study period. A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled. Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors. Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI). Overweight (BMI 25 kg/m²) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI <25. Obesity (BMI 30) among men and morbid obesity (BMI 35) among women anytime during lifetime was linked to three- to four-fold increases in risk. The strongest association was with diabetic nephropathy, but two- to three-fold risk elevations were observed for all major subtypes of CRF. Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant. Obesity seems to be an important—and potentially preventable—risk factor for CRF. Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist.

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