EFFECT OF KIDNEY FUNCTION ON THE ASSOC BETW OBESITY AND CARDIOVASCULAR EVENTS

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 这项建议的目的是阐明肾功能下降对超重或肥胖患者心血管事件(CV)风险的临床影响。 最近的报告表明，在普通人群中，超重或肥胖是心血管事件和死亡的已知风险因素。矛盾的是，大量证据表明，在终末期肾病(ESRD)患者中，高体重指数(BMI)似乎比BMI25提供了更长的生存时间。然而，在一般的人口研究中，个体被随访15到30年，而终末期肾病患者的预期寿命要短得多。此外，在ESRD人群中进行的所有研究都是基于血液透析开始时报告的BMI。众所周知，在血液透析前，肾功能低下的患者往往会因为尿毒症引起的厌食症或严重的合并症加重而体重减轻。透析开始时体重指数正常或偏低的患者实际上可能是因为健康状况不佳而在减肥过程中的患者。 在终末期肾病之前肾功能下降的患者中，肥胖是否也更有可能与更长的生存期相关，目前尚不清楚。 我们建议在特拉华州几家门诊接受临床护理的患者中，研究体重指数和肾功能之间的相关性，所有患者都使用电子医疗记录。本研究将对患者进行回顾性纵向分析。我们将首先确定肾功能的纵向下降是否会改变肥胖和心血管事件之间的联系(目标1)。为此，我们将建立BMI和BMI+肾功能的纵向模型，并将它们与心血管累积事件发生率相互关联。类似的相互关联模式将表明，肾功能不会改变肥胖和心血管事件之间的关联。然后，我们将确定血液透析开始前体重变化对血液透析患者心血管事件发生率的影响(目标2)。为此，我们将使用Cox比例风险回归模型来估计体重变化和其他可能影响心血管事件发生率的协变量可能影响心血管事件发生率的风险比。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. The purpose of this proposal is to clarify the clinical impact of a decline of kidney function on the risk of cardiovascular (CV) events in patients overweight or obese. Recent reports have demonstrated that in the general population, being overweight or obese is a known risk factor for CV events and death. Paradoxically, a large body of evidence has shown that in the population of end-stage renal disease (ESRD) patients, a high body mass index (BMI) seems to provide a longer survival, compared to a BMI25. However, in the general population studies, individuals are followed up for 15 to 30 years whereas ESRD patients have a much shorter life expectancy. Moreover, all the studies conducted in the ESRD population have been based on BMI reported at initiation of hemodialysis. It is well known that prior to hemodialysis, patients with low kidney function often experience weight loss because of uremia-induced anorexia or severe exacerbation of comorbidities. Patients with normal or low BMI at dialysis' initiation may be in fact patients who are in the process of losing weight because of poor health. Whether obesity is also more likely to be associated with longer survival in patients with a decrease in kidney function prior to the stage of ESRD is unclear. We propose to examine the association between BMI and kidney function on the risk of CV events in a population of patients followed for their clinical care in several out-patient clinics in Delaware, all using electronic medical records. This study will be a retrospective longitudinal analysis of patients. We will first determine whether a longitudinal decline in kidney function modifies the association between obesity and CV events (aim 1). To do so, we will develop longitudinal models of BMI and BMI + kidney function, and cross-correlate each of these with CV cumulative event rates. Similar cross-correlation patterns would indicate that kidney function does not modify the association between obesity and CV events. Then, we will determine the effects of weight changes prior to the initiation of hemodialysis on CV events rates in patients in hemodialysis (aim 2). To do so, we will use a Cox proportional hazard regression model to estimate hazard ratios for weight change and other covariates potentially influencing cardiovascular event rates potentially influencing cardiovascular event rates.