Kidney Week

Abstract: TH-PO1036

Impact of Obesity on the Associations of Cystatin C-Based eGFR with Clinical Outcomes

Session Information

• CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Chen, Debbie, University of California San Francisco, San Francisco, California, United States

Debbie Chen,

• Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States

Rebecca Scherzer,

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix,

• Kramer, Holly J., Loyola University Health System, Maywood, Illinois, United States

Holly J. Kramer,

• Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States

Deidra C. Crews,

• Nadkarni, Girish N., Mount Sinai Health System, New York, New York, United States

Girish N. Nadkarni,

• Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Orlando M. Gutierrez,

• Ilori, Titilayo O., Boston University, Boston, Massachusetts, United States

Titilayo O. Ilori,

• Bullen, Alexander L., University of California San Diego, La Jolla, California, United States

Alexander L. Bullen,

• Garimella, Pranav S., University of California San Diego, La Jolla, California, United States

Pranav S. Garimella,

• Shlipak, Michael, San Francisco VA Health Care System, San Francisco, California, United States

Michael Shlipak,

• Estrella, Michelle M., San Francisco VA Health Care System, San Francisco, California, United States

Michelle M. Estrella,

Background

Cystatin C-based eGFR (eGFRcys) has stronger associations with adverse clinical outcomes than creatinine-based eGFR (eGFRcr). Obesity may be associated with higher cystatin C levels, independent of kidney function, but whether obesity affects the prognostic utility of eGFRcys is unknown.

Methods

This prospective cohort study included 27,249 US adults enrolled in the Reasons for Geographic and Racial Differences in Stroke study between 2003 and 2007. We constructed multivariable Cox and Fine-Gray models with multiplicative interaction terms to investigate whether waist circumference (WC) quartiles modified associations of eGFR with risks of all-cause mortality, ESKD, incident atherosclerotic cardiovascular disease (ASCVD), and incident heart failure (HF).

Results

Participants had a mean age of 65 y; 54% were women, and 41% were Black. Baseline prevalence of abdominal obesity (WC ≥88 cm for women or ≥102 cm for men) was 48% and obesity (BMI ≥30 kg/m²) was 38%. During a median follow-up time of 12.1 years, 9350 (34%) participants died, 511 (2%) developed ESKD, 2271 (11%) had an incident ASCVD event, and 1053 (4%) had an incident HF hospitalization. In adjusted analyses (Table 1), each 15-mL/min/1.73 m² lower eGFRcys was associated with higher risk of mortality in each WC quartile (Q1: HR 1.10 [1.15, 1.24]; Q2: HR 1.22 [1.18, 1.26]; Q3: HR 1.20 [1.16, 1.24]; Q4: 1.19 [1.15, 1.23]). WC did not modify associations of eGFRcys with mortality (p-interaction >0.05). Similarly, WC did not modify associations of eGFRcys with the other outcomes (all p-interactions >0.05). Compared with eGFRcr, eGFRcys had stronger associations with mortality in all WC quartiles (p<0.001 in all quartiles).

Conclusion

The association of eGFRcys with adverse outcomes did not differ by WC. Among individuals with obesity, cystatin C may be used to examine associations of eGFR with important clinical adverse outcomes related to kidney disease.

Funding

• Other NIH Support