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Abstract
Background/objectives
We aimed to evaluate the relationship between BMI and the risk of renal disease in patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study.
Subjects/methods
Participants were divided into six baseline BMI categories: <18.5 (underweight, n = 58); ≥18.5 to <25 (normal, n = 2894); ≥25 to <30 (overweight, n = 4340); ≥30 to <35 (obesity grade 1, n = 2265); ≥35 to <40 (obesity grade 2, n = 744); and ≥40 kg/m2 (obesity grade 3, n = 294); those underweight were excluded. The composite outcome “major renal event” was defined as development of new macroalbuminuria, doubling of creatinine, end stage renal disease, or renal death. These outcomes and development of new microalbuminuria were considered individually as secondary endpoints.
Results
During 5-years of follow-up, major renal events occurred in 487 (4.6%) patients. The risk increased with higher BMI. Multivariable-adjusted HRs (95% CIs), compared to normal weight, were: 0.91 (0.72–1.15) for overweight; 1.03 (0.77–1.37) for obesity grade 1; 1.42 (0.98–2.07) for grade 2; and 2.16 (1.34–3.48) for grade 3 (p for trend = 0.006). These findings were similar across subgroups by randomised interventions (intensive versus standard glucose control and perindopril-indapamide versus placebo). Every additional unit of BMI over 25 kg/m2 increased the risk of major renal events by 4 (1–6)%. Comparable results were observed with the risk of secondary endpoints.
Conclusions
Higher BMI is an independent predictor of major renal events in patients with type 2 diabetes. Our findings encourage weight loss to improve nephroprotection in these patients.
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Details
1 The George Institute for Global Health, University of Sydney, Sydney, Australia; INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France
2 The George Institute for Global Health, University of Sydney, Sydney, Australia
3 Nuffield Department of Population Health, University of Oxford, Oxford, UK
4 The University of Milan-Bicocca and Istituto Auxologico Italiano, Milan, Italy
5 INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France; Sorbonne Paris Cité, UFR de Médecine, University Paris Diderot, Paris, France
6 The International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK
7 Institute of Cardiovascular Sciences, University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre, London, UK
8 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
9 The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; The George Institute for Global Health, University of Oxford, Oxford, UK