Neck circumference predicts renal function decline in overweight women A community-based prospective cohort study

Chronic kidney disease (CKD) is characterized by increased risks of morbidity and mortality. Upper-body subcutaneous fat, which is commonly estimated from the neck circumference (NC), was revealed to be the main reservoir of circulating nonesterified fatty acids in overweight patients. Despite a close association between NC and metabolic complications, the relationship of NC with renal function has not been fully investigated. In this study, the impact of NC on the development of incident CKD was elucidated. The data were retrieved from the Korean Genome and Epidemiology Study cohort. The subjects were followed at 2-year intervals from 2003 to 2011. Overweight was defined as a body mass index of ?23kg/m2. A total of 4298 cohort subjects were screened. After exclusion, 2268 overweight subjects were included for the final analysis. The primary end point was incident CKD, which was defined as a composite of estimated glomerular filtration rate (EGFR)<60mL/min/1.73m2 or the development of proteinuria. The mean patient age was 36.3±3.0 years, and 1285 (56.7%) were men. They were divided into 2 groups according to the median NC in male and female subjects, separately. In both sexes, hypertension (men, P<0.001; women, P=0.009) and diabetes (men, P= 0.002; women, P<0.001) were significantly more prevalent in the big NC group than in the small NC group. In contrast, EGFR was significantly lower only in male subjects of the big NC group (P<0.001), whereas it was comparable between the small and big NC groups (P=0.167). In multivariate Cox proportional hazards regression analysis, NC values were independently associated with incident CKD development in female subjects after adjusting for multiple confounding factors (per 1cm increase, hazard ratio [95% confidence interval]=1.159 [1.024-1.310], P=0.019) but not in male subjects. NC is independently associated with the development of CKD in overweight female subjects, suggesting that it could be a practical risk factor for CKD.