Overweight and Obesity Are Predictors of Progression in Early Autosomal Dominant Polycystic Kidney Disease

The association of overweight/obesity with disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD) remains untested. We hypothesized that overweight/obesity associates with faster progression in early-stage ADPKD. Overall, 441 nondiabetic participants with ADPKD and an eGFR>60 ml/min per 1.73m(2) who participated in the Halt Progression of Polycystic Kidney Disease Study A were categorized on the basis of body mass index (BMI; calculated using nonkidney and nonliver weight) as normal weight (18.5-24.9 kg/m(2); reference; n=192), overweight (25.0-29.9 kg/m(2); n=168), or obese (>= 30 kg/m(2); n=81). We evaluated the longitudinal (5-year) association of overweight/obesity with change in total kidney volume (TKV) by magnetic resonance imaging using linear regression and multinomial logistic regression models. Among participants, mean +/- SD age was 37 +/- 8 years, annual percent change in TKV was 7.4%+/- 5.1%, and BMI was 26.3 +/- 4.9 kg/m(2). The annual percent change in TKV increased with increasing BMI category (normal weight: 6.1%+/- 4.7%, overweight: 7.9% 64.8%, obese: 9.4%+/- 6.2%; P<0.001). In the fully adjusted model, higher BMI associated with greater annual percent change in TKV (beta=0.79; 95% confidence interval [ 95% CI], 0.18 to 1.39, per 5-unit increase in BMI). Overweight and obesity associated with increased odds of annual percent change in TKV >= 7% compared with <5% (overweight: odds ratio, 2.02; 95% CI, 1.15 to 3.56; obese: odds ratio, 3.76; 95% CI, 1.81 to 7.80). Obesity also independently associated with greater eGFR decline (slope) versus normal weight (fully adjusted beta=-0.08; 95% CI, -0.15 to -0.02). In conclusion, overweight and, particularly, obesity are strongly and independently associated with rate of progression in early-stage ADPKD.