Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Keiichi Sumida, Lucia Kwak, Morgan Grams, Kunihiro Yamagata, Naresh M Punjabi, Csaba P. Kovesdy, Josef Coresh, Kunihiro Matsushita

Research output: Contribution to journalArticle

Abstract

Background: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results: During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - 2017

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Vital Capacity
Kidney Diseases
Atherosclerosis
Lung
Chronic Renal Insufficiency
Chronic Kidney Failure
Spirometry
Renal Replacement Therapy
Forced Expiratory Volume
Glomerular Filtration Rate
Disease Progression
Hospitalization
Cohort Studies
Cardiovascular Diseases
Prospective Studies

Keywords

  • Atherosclerosis Risk in Communities (ARIC) Study
  • Chronic kidney disease (CKD)
  • End-stage renal disease (ESRD)
  • Estimated glomerular filtration rate (eGFR)
  • Lung function
  • Obstructive lung function
  • Restrictive lung function
  • Spirometry

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{3d5330a2fca643cea7f2b17003a607d5,
title = "Lung Function and Incident Kidney Disease: The Atherosclerosis Risk in Communities (ARIC) Study",
abstract = "Background: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0{\%} men and 25.2{\%} black), with follow-up through 2012. Predictors: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25{\%} decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results: During a median follow-up of 23.6 years, 526 (3.5{\%}) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95{\%} CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95{\%} CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80{\%} and FEV1/FVC<70{\%}; 3.4{\%} of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95{\%} CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80{\%} and FEV1/FVC≥70{\%}; 4.8{\%} of participants) at 2.03 (95{\%} CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80{\%} and FEV1/FVC<70{\%}; 18.9{\%} of participants) at 1.47 (95{\%} CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80{\%}-<100{\%} and FEV1/FVC≥70{\%}, or percent-predicted FVC≥80{\%} and FEV1/FVC 70{\%}-<75{\%}; 44.3{\%} of participants) at 1.21 (95{\%} CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.",
keywords = "Atherosclerosis Risk in Communities (ARIC) Study, Chronic kidney disease (CKD), End-stage renal disease (ESRD), Estimated glomerular filtration rate (eGFR), Lung function, Obstructive lung function, Restrictive lung function, Spirometry",
author = "Keiichi Sumida and Lucia Kwak and Morgan Grams and Kunihiro Yamagata and Punjabi, {Naresh M} and Kovesdy, {Csaba P.} and Josef Coresh and Kunihiro Matsushita",
year = "2017",
doi = "10.1053/j.ajkd.2017.05.021",
language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Lung Function and Incident Kidney Disease

T2 - The Atherosclerosis Risk in Communities (ARIC) Study

AU - Sumida, Keiichi

AU - Kwak, Lucia

AU - Grams, Morgan

AU - Yamagata, Kunihiro

AU - Punjabi, Naresh M

AU - Kovesdy, Csaba P.

AU - Coresh, Josef

AU - Matsushita, Kunihiro

PY - 2017

Y1 - 2017

N2 - Background: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results: During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

AB - Background: Reduced lung function is associated with clinical outcomes such as cardiovascular disease. However, little is known about its association with incident end-stage renal disease (ESRD) and chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: 14,946 participants aged 45 to 64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study (45.0% men and 25.2% black), with follow-up through 2012. Predictors: Race- and sex-specific quartiles of percent-predicted forced vital capacity (FVC) and the proportion of forced expiratory volume in 1 second of expiration to FVC (FEV1/FVC) at baseline determined with spirometry. Outcomes: Incident ESRD (defined here as renal replacement therapy or death due to CKD) as the primary outcome and incident CKD (defined here as ESRD, ≥25% decline in estimated glomerular filtration rate to a level <60mL/min/1.73m2, or CKD-related hospitalizations/deaths) as the secondary outcome. Results: During a median follow-up of 23.6 years, 526 (3.5%) participants developed ESRD. After adjusting for potential confounders, the cause-specific HR of incident ESRD for the lowest (vs highest) quartile was 1.72 (95% CI, 1.31-2.26) for percent-predicted FVC and 1.33 (95% CI, 1.03-1.73) for FEV1/FVC. Compared to a high-normal lung function pattern, a mixed pattern (ie, percent-predicted FVC<80% and FEV1/FVC<70%; 3.4% of participants) demonstrated the highest adjusted cause-specific HR of ESRD at 2.28 (95% CI, 1.50-3.45), followed by the restrictive pattern (ie, percent-predicted FVC<80% and FEV1/FVC≥70%; 4.8% of participants) at 2.03 (95% CI, 1.47-2.81), obstructive pattern (ie, percent-predicted FVC≥80% and FEV1/FVC<70%; 18.9% of participants) at 1.47 (95% CI, 1.09-1.99), and low-normal pattern (ie, percent-predicted FVC 80%-<100% and FEV1/FVC≥70%, or percent-predicted FVC≥80% and FEV1/FVC 70%-<75%; 44.3% of participants) at 1.21 (95% CI, 0.94-1.55). Similar associations were seen with incident CKD. Limitations: Limited number of participants with moderate/severe lung dysfunction and spirometry only at baseline. Conclusions: Reduced lung function, particularly lower percent-predicted FVC, is independently associated with CKD progression. Our findings suggest a potential pathophysiologic contribution of reduced lung function to the development of CKD and a need for monitoring kidney function in persons with reduced lung function.

KW - Atherosclerosis Risk in Communities (ARIC) Study

KW - Chronic kidney disease (CKD)

KW - End-stage renal disease (ESRD)

KW - Estimated glomerular filtration rate (eGFR)

KW - Lung function

KW - Obstructive lung function

KW - Restrictive lung function

KW - Spirometry

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U2 - 10.1053/j.ajkd.2017.05.021

DO - 10.1053/j.ajkd.2017.05.021

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JO - American Journal of Kidney Diseases

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