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Association of Visceral and Subcutaneous Adiposity with Kidney Function

Jill A. Young^*, Shih-Jen Hwang^,, Mark J. Sarnak^*, Udo Hoffmann, Joseph M. Massaro^,||, Daniel Levy^,, Emelia J. Benjamin^,¶, Martin G. Larson, Ramachandran S. Vasan^,¶, Christopher J. O’Donnell^,,, and Caroline S. Fox^,,**

^* Tufts-New England Medical Center; Massachusetts General Hospital and Harvard Medical School; ^|| Department of Mathematics and Statistics, Boston University; ^¶ Boston University School of Medicine and School of Public Health; ^** Department of Endocrinology, Hypertension, and Metabolism, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Framingham Heart Study; and Center for Populations Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland

Correspondence: Dr. Caroline S. Fox, 73 Mount Wayte Avenue Suite #2, Framingham, MA 01702. Phone: 508-935-3447; Fax: 508-626-1262; E-mail: foxca{at}nhlbi.nih.gov

Background and objectives: Obesity is a risk factor for incident chronic kidney disease (CKD). Visceral (VAT) and subcutaneous adipose tissue (SAT) may confer differential metabolic risk profiles. The relations of VAT and SAT were analyzed with CKD as estimated by creatinine- and cystatin-based estimating equations.

Design, setting, participants, & measurements: Participants from the Framingham Offspring Study who underwent abdominal computed tomography for VAT and SAT quantification were included (n = 1299; 53% women; mean age 60 yr). CKD was defined as estimated GFR <60 ml/min per 1.73 m², as estimated using creatinine (n = 89) in the Modification of Diet in Renal Disease (MDRD) formula or by cystatin C (n = 136). Regression models evaluated the cross-sectional relations between VAT and SAT with CKD and cystatin C, with age and gender adjustment and cardiovascular risk factor adjustment.

Results: Neither VAT nor SAT was associated with CKD as estimated by the MDRD equation. In contrast, both VAT and SAT were associated with CKD when defined using cystatin-based equations. The estimated decrease in estimated GFR by cystatin C per 1-SD increase of VAT was 1.9 ml/min per 1.73 m² and for SAT was 2.6 ml/min per 1.73 m² in a multivariable-adjusted model.

Conclusions: VAT and SAT were associated with CKD when defined using cystatin C estimating equations but not when using a creatinine-based estimating equation. Mechanisms linking adipose tissue to cystatin C warrant further research.