Body Mass Index and Early Kidney Function Decline in Young Adults: A Longitudinal Analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) Study
Open accessAbstract
Background Identifying potentially modifiable risk factors is critically important for reducing the burden of chronic kidney disease. We sought to examine the association of body mass index (BMI) with kidney function decline in a cohort of young adults with preserved glomerular filtration at baseline.Study design Longitudinal cohort.Setting & participants 2,839 black and white young adults with cystatin C-based estimated glomerular filtration rate (eGFRcys)>90mL/min/1.73m(2) taking part in the year-10 examination (in 1995-1996) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study.Predictor BMI, categorized as 18.5-24.9 (reference), 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2).Outcomes Trajectory of kidney function decline, rapid decline (>3% per year), and incident eGFRcys <60mL/min/1.73m(2) over 10 years of follow-up.Measurements GFRcys estimated from the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation for calibrated cystatin C at CARDIA years 10, 15, and 20.Results At year 10, participants had a mean age of 35.1 years, median eGFRcys of 114mL/min/1.73m(2), and 24.5% had BMI≥30.0kg/m(2). After age 30 years, average eGFRcys was progressively lower with each increment in BMI after adjustment for baseline age, race, sex, hyperlipidemia, smoking status, and physical activity. Higher BMI category was associated with successively higher odds of rapid decline (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), adjusted ORs were 1.50 [95% CI, 1.21-1.87], 2.01 [95% CI, 1.57-2.87], and 2.57 [95% CI, 1.67-3.94], respectively). 18 participants (0.6%) had incident eGFRcys<60mL/min/1.73m(2). In unadjusted analysis, higher BMI category was associated with incident eGFRcys<60mL/min/1.73m(2) (for 25.0-29.9, 30.0-39.9, and ≥40.0kg/m(2), ORs were 5.17 [95% CI, 1.10-25.38], 7.44 [95% CI, 1.54-35.95], and 5.55 [95% CI, 0.50-61.81], respectively); adjusted associations were no longer significant.Limitations Inability to describe kidney function before differences by BMI category were already evident. Absence of data for measured GFR or GFR estimated from serum creatinine level.Conclusions Higher BMI categories are associated with greater declines in kidney function in a cohort of young adults with preserved GFR at baseline. Clinicians should vigilantly monitor overweight and obese patients for evidence of early kidney function decline.
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Alterations in renal excretory function occur prior to the onset of obesity hypertension in animal models and humans.
“Longitudinal studies have shown that alterations in renal excretory function occur prior to the onset of obesity hypertension in animal models and humans (61;62) indicating that renal dysfunction may drive arterial pressure elevation in obesity.”
From Obesity-Associated Hypertension: Recent Progress in Deciphering the Pathogenesis (2014) · cites this paper as [61]
Renal dysfunction may drive arterial pressure elevation in obesity.
“Longitudinal studies have shown that alterations in renal excretory function occur prior to the onset of obesity hypertension in animal models and humans (61;62) indicating that renal dysfunction may drive arterial pressure elevation in obesity.”
From Obesity-Associated Hypertension: Recent Progress in Deciphering the Pathogenesis (2014) · cites this paper as [61]
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“85 times higher risk of rapid kidney function decline (>3% eGFR per year) compared to normal weight individuals.(2) Others have shown that being overweight at a younger age 2 (a)”
BackgroundXu, L., Wang, N., Chen, X., Liang, Y., Zhou, H., & Yan, J. (2018) · Medicine · doi:10.1097/md.0000000000012448 · Cited by 19 · see citing works
Esmeijer, K., Geleijnse, J., de Fijter, J., Giltay, E., Kromhout, D., & Hoogeveen, E. (2018) · Kidney International Reports · doi:10.1016/j.ekir.2018.03.005 · Cited by 15 · see citing works
“In line with other studies, we found that obesity was associated with faster kidney function decline.(8,43) Obesity promotes deterioration of kidney function through cardiovascular risk factors such as diabetes and hypertension, and is also associated with visceral fat accumulation and accompanying inflammation, leadi…”
ResultJohnson, H. M., Sullivan-Vedder, L., Kim, K., McBride, P. E., Smith, M. A., LaMantia, J. N., Fink, J. T., Sinaise, M. R. K., Zeller, L. M., & Lauver, D. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.01.010 · Cited by 19 · see citing works
“Over 10 million 18–39 year-olds (1 in 5 men; 1 in 6 women) have hypertension [4–6], increasing their risk of premature heart failure, stroke, and chronic kidney disease [7, 8].”
BackgroundChoi, J. I., Cho, Y. H., Lee, S. Y., Jeong, D. W., Lee, J. G., Yi, Y. H., Tak, Y. J., Lee, S. H., Hwang, H. R., & Park, E. J. (2019) · Korean Journal of Family Medicine · doi:10.4082/kjfm.18.0139 · Cited by 16 · see citing works
The association between the body roundness index and the risk of chronic kidney disease in US adults
Zhang, J., & Yu, X. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1495935 · Cited by 15 · see citing works
Bonito, P. D., Licenziati, M. R., Campana, G., Chiesa, C., Pacifico, L., Manco, M., del Giudice, E. M., Sessa, A. D., Baroni, M. G., Marzuillo, P., et al. (2021) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2020.11.005 · Cited by 15 · see citing works
Gonçalves‐Rizzi, V. H., Sene, L. D. B., Fernandez, C. D. B., Gontijo, J. A. R., & Boer, P. A. (2016) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174416000398 · Cited by 14 · see citing works
“These habits interact with genetic factors, which may explain the increasing rates of excessive body fat worldwide.(8,9) Early high-fat diet (HFD) intake and obesity are related to the increased prevalence of cardiovascular disease, dyslipidemia, type 2 diabetes mellitus and chronic kidney disease.”
BackgroundChildren with CKD Are Not Little Adults with CKD
Kula, A. J., Somers, M. J. G., & on behalf of the American Society of Pediatric Nephrology (2020) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.11540720 · Cited by 13 · see citing works
“Ensuing metabolic complications affect kidney health earlier in life, subsequently swelling the ranks of adults with CKD and kidney failure (2).”
BackgroundAldemir, M., Koca, H. B., Bakı, E. D., Çarşanba, G., Öztürk, N. K., Kavaklı, A. S., Adalı, F., Emmıler, M., & Darçın, O. T. (2015) · The Anatolian Journal of Cardiology · doi:10.5152/anatoljcardiol.2015.6287 · Cited by 11 · see citing works
“It has been suggested that higher BMI is associated with a greater decline in kidney function in young adults with preserved GFR at baseline (37).”
BackgroundZhan, Y., Shi, H., Caligiuri, S. P. B., Wu, Y., DeClercq, V., Taylor, C. G., Zahradka, P. C., Ogborn, M. R., & Aukema, H. M. (2014) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2014.09.011 · Cited by 11 · see citing works
“Obesity is strongly associated with renal injury and an increased risk of progression to end-stage renal disease (ESRD) in both older and younger adults [1–5].”
BackgroundJohnson, H. M., LaMantia, J. N., Brown, C. M., Warner, R. C., Zeller, L. M., Haggart, R. C., Stonewall, K., & Lauver, D. (2017) · JMIR Cardio · doi:10.2196/cardio.8025 · Cited by 9 · see citing works
He, Y., Liu, D., Tan, W., Ma, X., Lian, F., & Xu, X. (2016) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2016.04.006 · Cited by 10 · see citing works
Association between body roundness index and advanced cardiovascular-kidney-metabolic syndrome
Chen, Y., Tu, H., Liang, M., & Shen, M. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1623766 · Cited by 9 · see citing works
Kanda, E., Muneyuki, T., Suwa, K., & Nakajima, K. (2015) · PLoS ONE · doi:10.1371/journal.pone.0143434 · Cited by 9 · see citing works
“On the other hand, the Coronary Artery Risk Development in Young Adults study showed that in both young males and females (average age, 35 years), high BMI is associated with a rapid decrease in eGFR [32].”
BackgroundIncreasing Body Mass Index Predicts Rapid Decline in Renal Function: A 5 Year Retrospective Study
Ma, X., Zhang, C., Su, H., Gong, X., & Kong, X. (2018) · Hormone and Metabolic Research · doi:10.1055/a-0599-6360 · Cited by 9 · see citing works
Brennan, A. T., Kileel, E. M., Khoza, S. P., Crowther, N. J., Bor, J. H., Fox, M. P., Rosen, S. B., Hibberd, P. L., Raal, F. J., Chetty, K., et al. (2024) · BMJ Public Health · doi:10.1136/bmjph-2023-000799 · Cited by 8 · see citing works
Guiney, H., Walker, R. J., Broadbent, J. M., Caspi, A., Goodin, E. A., Kokaua, J., Moffitt, T. E., Robertson, S., Theodore, R. F., Poulton, R., et al. (2022) · Kidney International Reports · doi:10.1016/j.ekir.2022.10.005 · Cited by 8 · see citing works
“High-risk trajectory group 46 5 (11%) (5) 1.”
Body mass index and annual estimated GFR decline in Chinese adults with normal renal function
Li, Y., Qin, X., Xie, D., Tang, G., Xing, H., Li, Z., Xu, X., Hou, F. F., & Xu, X. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2014.221 · Cited by 8 · see citing works
Obesity Related Glomerulopathy in Adolescent Women: The Effect of Body Surface Area
Bielopolski, D., Singh, N., Bentur, O. S., Renert‐Yuval, Y., MacArthur, R., Vasquez, K. S., Moftah, D. S., VAUGHAN, R. D., Charytan, D. M., Kost, R. G., et al. (2021) · Kidney360 · doi:10.34067/kid.0005312021 · Cited by 8 · see citing works
“As BMI increases, kidney function declines, and the decline is more rapid with higher BMI (30).”
BackgroundAbdominal obesity and reduction of glomerular filtration
Dias, R. S. C., Calado, I. L., de Alencar, J. D., Hortegal, E. V., Santos, E. J. F., Brito, D. J. D. A., Lages, J. S., dos Santos, A. M., & Filho, N. S. (2018) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.64.04.346 · Cited by 7 · see citing works
Moreno, J. M., Tapia, A., Martínez, C. M., Reverte, V., Oltra, L., Llinás, M. T., & Salazar, F. J. (2018) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00394.2018 · Cited by 7 · see citing works
Renal Cellular Autophagy in Obesity: Boon or Bane?
Ghandriz, R., & Lerman, L. O. (2021) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2021.06.006 · Cited by 6 · see citing works
Kosmeri, C., Siomou, E. C., Vlahos, A. P., & Milionis, H. J. (2018) · Acta Paediatrica · doi:10.1111/apa.14529 · Cited by 5 · see citing works
“Nevertheless, the Coronary Artery Risk Development in Young Adults study found no association between hyperlipidaemia and a decline in GFR in 2891 young adults, and high BMI was associated with a decline in renal function (33).”
BackgroundPérez-Navarro, L. M., Valdez-Ortiz, R., Alegría-Díaz, A., Murguía‐Romero, M., Jiménez-Flores, R., Villalobos‐Molina, R., Mummidi, S., Duggirala, R., & López-Alvarenga, J. C. (2020) · Revista de investigaci�n Cl�nica · doi:10.24875/ric.19003204 · Cited by 5 · see citing works
Harhay, M., Kim, Y., Moore, K. A., Harhay, M. O., Katz, R., Shlipak, M. G., & Mattix-Kramer, H. J. (2023) · Obesity · doi:10.1002/oby.23883 · Cited by 3 · see citing works
“Obesity, whether defined by body mass index (BMI) [2] or by anthro-pometry (i.e., waist circumference and waist-hip ratio), is a known CKD risk factor [3 – 7].”
BackgroundSelf-citationMedeiros, T., do Rosário, N. F., Gama, N. A., Mérida, L. A. D., Storch, A. S., Ferraz, L., Lopes, P. D. F., Silva, A. A., & Almeida, J. R. (2017) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2017.03.015 · Cited by 2 · see citing works
“Several authors reported the association between obesity and CKD [24,25].”
BackgroundLuo, P., Li, D., Guo, Y., Meng, X., Kan, R., Pan, L., Xiang, Y., Mao, B., He, Y., Wang, S., et al. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02496-5 · Cited by 2 · see citing works
“The covariates in fully adjusted Cox regression models were generated according to previous publications and potential risk factors related to the development and progression of kidney function decline, CVD events, and all-cause mortality from clinical experience [3, 14, 15,38–41].”
MethodJulián, M. T., Codina, P., Lupón, J., Zamora, E., de, A. P.-M., Domingo, M., Santiago‐Vacas, E., Borrellas, A., Ruiz-Cueto, M., González-Gallego, C., et al. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-025-02632-9 · Cited by 2 · see citing works
“Obesity is strongly related to the risk of CKD development and progression, even after adjustment for other confounding factors [45–47].”
Nagai, K., Nakajima, M., & Yoshii, S. (2022) · JMA Journal · doi:10.31662/jmaj.2021-0223 · Cited by 1 · see citing works
“Moreover, obesity has been associated with the risk for chronic kidney disease (CKD), which is defined as persistent proteinuria and/or renal dysfunction for more than 3 months ((1)).”
BackgroundKula, A. J. (2025) · Pediatric Drugs · doi:10.1007/s40272-025-00684-8 · Cited by 1 · see citing works
“Multiple pediatric risk factors increase a person’s risk for developing CKD in adolescence or young adulthood, including prematurity, acute kidney injury, obesity, hypertension, and diabetes [3–5].”
Brennan, A. T., Kileel, E. M., Khoza, S. P., Crowther, N. J., Bor, J. H., Fox, M. P., Rosen, S. B., Hibberd, P. L., Raal, F. J., Chetty, K., et al. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4603261 · Cited by 1 · see citing works
Modifiers of the Kidney Response to Activation of the Renin-Angiotensin System: ACE2 and Adiponectin
Fang, F. (2014) · TSpace (University of Toronto)
Thawornchaisit, P., de Looze, F., Reid, C. M., Seubsman, S., & Sleigh, A. C. (2018) · Global Journal of Health Science · doi:10.5539/gjhs.v10n3p132
“, 2008) and in follow up studies of 10 to 12 years in the US (Grubbs et al., 2014; Stengel, Tarver-Carr, Powe, Eberhardt, & Brancati, 2003) and 25 years in Israeli (Vivante et al.”
BackgroundIs there improvement in renal function in patients undergoing bariatric surgery?
Bezerra, J. A. B., Ct, B., Borborema, D. M. B., Ramos, A. Q., de Souza, M., & Maciel, F. A. M. F. (2019) · Journal of Clinical Nephrology · doi:10.29328/journal.jcn.1001039
The Effects of Polypharmacy on Liver Disease and Kidney Dysfunction in Older Adults
강현진 (2020) · Seoul National University Open Repository (Seoul National University)
Obesity Related Glomerulopathy: weighing in the effect of Body Surface AreaPreprint
Bielopolski, D., Singh, N. C., Ohad, S. B., Renert‐Yuval, Y., Robert, M., Kimberly, S. V., Dena, S. M., Roger, D. V., Rhonda, G., & Jonathan, N. T. (2021) · medRxiv · doi:10.1101/2021.03.11.21253278
Kramer, H., & Navaneethan, S. D. (2019) · Nephrology Self-Assessment Program · doi:10.1681/nsap.2019.18.4.4
Does Bariatric Surgery Improve Kidney Function in obese Patients? A Cohort Study
Bezerra, J. A. B. (2021) · International Journal of Clinical Nephrology · doi:10.31579/2834-5142/013
Haeger, S. M., & Bansal, N. (2025) · JAMA Cardiology · doi:10.1001/jamacardio.2025.3276
Self-citationMao, B.-B., Xiang, Y., Luo, P.-Q., Li, D., Guo, Y., Meng, X., Kan, R., Pan, L.-M., He, Y., Wang, S.-Y., et al. (2025) · Current Medical Science · doi:10.1007/s11596-025-00146-9
“Covariates in the fully adjusted regression models were selected based on clinical relevance, scientific evidence, and their established predictive value for the development and progression of kidney function decline, CVD, and all-cause mortality in previously published literature [1, 3, 17, 36–38].”
Kidney transplantation in obese Black patients: Strategies to improve access and outcomes
Oluyombo, R., Karim, M., Mason, S. R., & Halawa, A. M. (2026) · World Journal of Nephrology · doi:10.5527/wjn.v15.i1.114527
Zhang, D., Kang, J., Zhang, Y., Yan, R., Guo, L., & Li, X. (2026) · BMC Geriatrics · doi:10.1186/s12877-026-07608-2
“Young adults with a BMI ≥ 25 kg/m² (and no baseline kidney disease) experienced a faster decline in eGFR over a 10-year follow-up period, and those with a BMI ≥ 40 kg/ m² had a 10-fold increased risk of renal function decline compared with individuals with normal weight (BMI 18.5–24.9 kg/m²) [12].”
InfluentialEfeitos da sobrecarga calórica em ratos machos submetidos ou não a restrição protéica in útero
Gonçalves‐Rizzi, V. H. (2014) · Americanae (AECID Library)
- Authors
- Grubbs, V., Lin, F., Vittinghoff, E., Shlipak, M. G., Peralta, C. A., Bansal, N., Jacobs, D. R., Siscovick, D. S., Lewis, C. E., & Bibbins-Domingo, K.
- Affiliations
- University of California, San Francisco (US)
- San Francisco VA Medical Center (US)
- University of Minnesota (US)
- University of Washington (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Grubbs, Vanessa
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 63
- Issue
- 4
- Pages
- 590-597
- ISSN
- 0272-6386 (ISSN-L)
- PMC
- PMC3969447
- OpenAlex
- W2156050980
- Cited by
- 79
- References
- 39
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 8 · 2020: 5 · 2019: 9 · 2018: 11 · 2017: 6 · 2016: 6 · 2015: 9 · 2014: 7
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (n01hc48050-59-0-1, KL2TR000143)
- National Heart, Lung, and Blood Institute (HHSN268201300028C, HHS-N2-68201300029C, HHSN268201300027C, HHSN268200900041C, HHSN268201300026C, HHS-N2-68201300025C, N01 HC048050)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK103992, R01DK078124, K23DK093710, P30DK092924, P30DK079626)
- National Center for Advancing Translational Sciences
- National Institute on Minority Health and Health Disparities (P60MD006902)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- body mass index, obesity, renal function decline, chronic kidney disease, cystatin C, estimated glomerular filtration rate, young adults, preserved renal function, risk factors, CARDIA study, racial differences, sex differences, physical activity, smoking, hyperlipidemia, modifiable risk factors, CKD-EPI equation, longitudinal trajectories
- MeSH terms
- Adolescent, Female, Glomerular Filtration Rate, Humans, Kidney, Longitudinal Studies, Male, Obesity, Risk Factors, Cohort Studies, Body Mass Index, Multivariate Analysis, Renal Insufficiency, Chronic, Cystatin C, Young Adult
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