Fatty Kidney, Hypertension, and Chronic Kidney Disease: The Framingham Heart Study
Open accessAbstract
Ectopic fat depots may mediate local and systemic disease. Animal models of diet-induced obesity demonstrate increased fat accumulation in the renal sinus. The association of renal sinus fat with hypertension, chronic kidney disease, and other metabolic disorders has not been studied in a large, community-based sample. Participants from the Framingham Heart Study (n=2923; mean age: 54 years; 51% women) underwent quantification of renal sinus fat area using computed tomography. High renal sinus fat (“fatty kidney”) was defined using sex-specific 90th percentiles in a healthy referent subsample. Multivariable linear and logistic regression was used to model metabolic risk factors as a function of fatty kidney and log-transformed renal sinus fat. Multivariable models were adjusted for age, sex, and outcome-specific covariates and then additionally adjusted for body mass index or abdominal visceral adipose tissue. The prevalence of fatty kidney was 30.1% (n=879). Individuals with fatty kidney had a higher odds ratio (OR) of hypertension (OR: 2.12; P <0.0001), which persisted after adjustment for body mass index (OR: 1.49; P <0.0001) or visceral adipose tissue (OR: 1.24; P =0.049). Fatty kidney was also associated with an increased OR for chronic kidney disease (OR: 2.30; P =0.005), even after additionally adjusting for body mass index (OR: 1.86; P =0.04) or visceral adipose tissue (OR: 1.86; P =0.05). We observed no association between fatty kidney and diabetes mellitus after adjusting for visceral adipose tissue. In conclusion, fatty kidney is a common condition that is associated with an increased risk of hypertension and chronic kidney disease. Renal sinus fat may play a role in blood pressure regulation and chronic kidney disease.
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Increased perirenal fat and hilar fat have been linked to CKD.
“Specifically, increased perirenal fat (46) and hilar fat (47) have been linked to CKD.”
From GLP-1 agonists in the treatment of chronic kidney disease in type 2 diabetes and obesity (2025) · cites this paper as [47]
Excessive adipose deposition around the kidneys, such as renal sinus fat and perirenal fat, may be associated with hypertension even after adjustment for traditional risk factors, including overall adiposity and BMI.
“Evidence suggests that excessive adipose deposition around the kidneys (for example, renal sinus fat (RSF) and perirenal fat (PRF)) may be associated with hypertension even after adjustment for traditional risk factors, including overall adiposity and BMI6,19–21.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [20]
In 2,923 participants from the Framingham Heart Study, high renal sinus fat levels conveyed a 2.2-fold increased risk of hypertension.
“In 2,923 participants from the Framingham Heart Study, high RSF levels (fatty kidney) conveyed a 2.2-fold increased risk of hypertension20.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [20]
High levels of renal sinus fat were also associated with a 2.3-fold increased risk of chronic kidney disease after adjusting for visceral adipose tissue and BMI.
“High levels of RSF were also associated with a 2.3-fold increased risk of CKD after adjusting for VAT and BMI20.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [20]
In the Framingham Heart Study, individuals with "fatty kidneys" (high perinephric fat levels) had more than a 2-fold higher risk for hypertension which persisted after adjustment for BMI and visceral fat.
“In the Framingham Heart Study, individuals with “fatty kidneys” (high perinephric fat levels) had more than a 2-fold higher risk for hypertension which persisted after adjustment for BMI and visceral fat32.”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [32]
Obesity is associated with several other changes in the kidney that promote the development of hypertension as well as chronic kidney disease and end-stage renal disease.
“Obesity is associated with several other changes in the kidney that promote the development of hypertension as well as chronic kidney disease and end-stage renal disease.”
From Obesity-Associated Hypertension: Recent Progress in Deciphering the Pathogenesis (2014) · cites this paper as [63]
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References 42 · Cited by 356
- Authors
- Foster, M. C., Hwang, S.-J., Porter, S. A., Massaro, J. M., Hoffmann, U., & Fox, C. S.
- Affiliations
- Boston University (US)
- Venue
- Hypertension
- Published
- 2011-11
- Volume
- 58
- Issue
- 5
- Pages
- 784-790
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC3204377
- OpenAlex
- W2121622684
- Cited by
- 356
- References
- 42
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 29 · 2023: 31 · 2022: 24 · 2021: 32 · 2020: 33 · 2019: 21 · 2018: 20 · 2017: 43 · 2016: 17 · 2015: 20 · 2014: 16 · 2013: 17 · 2012: 6
- FWCI
- 9.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 HL999999, n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (ZIAHL006094, N01‐HC25195, N01-HC-025195)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- renal sinus fat, ectopic fat, chronic kidney disease, visceral adipose tissue, body mass index, diabetes mellitus, metabolic risk factors, Framingham Heart Study
- MeSH terms
- Aged, Anthropometry, Blood Pressure Determination, Cardiovascular Diseases, Female, Heart Function Tests, Humans, Hypertension, Kidney Function Tests, Male, Massachusetts, Middle Aged, Prognosis, Retrospective Studies, Severity of Illness Index, Comorbidity, Body Mass Index, Incidence, Survival Rate, Case-Control Studies, Age Distribution, Sex Distribution, Risk Assessment, Intra-Abdominal Fat, Renal Insufficiency, Chronic
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