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Associations of body mass index (BMI) and BMI change with progression of chronic kidney disease in children

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Abstract

Background

Obesity is prevalent among children with chronic kidney disease (CKD) and is associated with cardiovascular disease and reduced quality of life. Its relationship with pediatric CKD progression has not been described.

Methods

We evaluated relationships between both body mass index (BMI) category (normal, overweight, obese) and BMI z-score (BMIz) change on CKD progression among participants of the Chronic Kidney Disease in Children study. Kaplan–Meier survival curves and multivariable parametric failure time models depict the association of baseline BMI category on time to kidney replacement therapy (KRT). Additionally, the annualized percentage change in estimated glomerular filtration rate (eGFR) was modeled against concurrent change in BMIz using multivariable linear regression with generalized estimating equations which allowed for quantification of the effect of BMIz change on annualized eGFR change.

Results

Participants had median age of 10.9 years [IQR: 6.5, 14.6], median eGFR of 50 ml/1.73 m2 [IQR: 37, 64] and 63% were male. 160 (27%) of 600 children with non-glomerular and 77 (31%) of 247 children with glomerular CKD progressed to KRT over a median of 5 years [IQR: 2, 8]. Times to KRT were not significantly associated with baseline BMI category. Children with non-glomerular CKD who were obese experienced significant improvement in eGFR (+ 0.62%; 95% CI: + 0.17%, + 1.08%) for every 0.1 standard deviation concurrent decrease in BMI. In participants with glomerular CKD who were obese, BMIz change was not significantly associated with annualized eGFR change.

Conclusion

Obesity may represent a target of intervention to improve kidney function in children with non-glomerular CKD.

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Abbreviations

BMI:

body mass index

CKD:

Chronic kidney disease

KRT:

Kidney replacement therapy

CKiD:

The Chronic Kidney Disease in Children study

eGFR:

Estimated glomerular filtration rate

CDC:

Centers for Disease Control and Prevention

BP:

Blood pressure

RT:

Relative times

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Acknowledgements

Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children's Mercy Hospital and the University of Missouri—Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD website is located at https://statepi.jhsph.edu/ckid and a list of CKiD collaborators can be found at https://statepi.jhsph.edu/ckid/site-investigators/. Please refer to the supplemental document which contains a list of the site principal investigators. This manuscript was presented in abstract form as oral platform presentation at the Pediatric Academic Society Annual Meeting 2021.

Funding

The CKiD Study is funded by the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U24-DK-082194, and U24-DK66116). None of the funding sources had a role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.

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Contributions

AJK, JR, MFS, and NMR contributed to research idea and study design; AJK, JR, MFS, MMM, BSZ, BAW, SLF, and NMR contributed to data analysis/interpretation, MMM, BSZ, BAW, SLF, and NMG contributed to supervision or mentorship. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual’s own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. AJK, JR, and MFS wrote the initial draft of the manuscript.

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Correspondence to Amy J. Kogon.

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Kogon, A.J., Roem, J., Schneider, M.F. et al. Associations of body mass index (BMI) and BMI change with progression of chronic kidney disease in children. Pediatr Nephrol 38, 1257–1266 (2023). https://doi.org/10.1007/s00467-022-05655-6

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