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CKD risk tied to diabetes, overweight, obesity in Asian adults
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Diabetes plus overweight or obesity increases the risk for chronic kidney disease among Asian adults, according to findings of a longitudinal study from Taiwan.
Hsin-Fang Chung, PhD, of the Institute of Population Health Sciences at National Health Research Institutes in Taiwan, and colleagues evaluated data from the Integrated Delivery System project on 1,187 Asian adults (mean age, 55.8 years) with type 2 diabetes who completed follow-up surveys in 2008, 2009 and 2010 to determine the relationships between the risk for CKD and obesity and weight changes. Follow-up was 7 years.
Estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 defined CKD. Normal weight was considered a BMI of 18.5 kg/m2 to 22.9 kg/m2, overweight was BMI 23 kg/m2 to 27.4 kg/m2 and obesity was BMI of at least 27 kg/m2. Abdominal obesity was defined at waist circumference of at least 80 cm for women and at least 90 cm for men.
Overall, 50% of participants had overweight, 30% had obesity and 61.4% had abdominal obesity.
Compared with participants with normal BMI and waist circumference, participants with obese BMI and obese waist circumference had significantly lower eGFR after adjustment for age, diabetes duration and sex (P < .05 in all surveys). Compared with participants with normal weight, participants with overweight (RR = 1.21; 95% CI, 0.93-1.59) and obesity (RR = 1.46; 95% CI, 1.07-2) had a higher risk for CKD. Similarly, the risk for CKD was increased with abdominal obesity (RR = 1.22; 95% CI, 1-1.49).
Among participants without CKD, 40% had a weight change from baseline to end of follow-up greater than 5%. The risk for developing CKD increased with weight gain of more than 10% compared with stable weight (RR = 1.43; 95% CI, 1.07-1.9) after adjustment for baseline BMI, HbA1c, triglycerides and hypertension. Similarly, the risk for CKD significantly increased with an increase in waist circumference from baseline to follow-up of more than 15% compared with stable waist circumference (RR = 1.37; 95% CI, 1.01-1.85). Risk factors for the development of CKD included retinopathy (RR = 1.61; 95% CI, 1.13-2.32) and albuminuria (creatinine ratio 30 mg/g; RR = 2.46; 95% CI, 1.73-3.5).
The rate of eGFR decline was greater among participants with a more than 10% weight gain compared with participants with stable weight (P = .105).
“These results provide clinical evidence that clinicians need to inform at-risk Asian patients of the effect of obesity using a lower BMI and [waist circumference], and to communicate the effect of weight gain on renal function decline more effectively to their diabetic patients,” the researchers wrote. “Larger, long-term prospective studies are needed to investigate the effects of insulin treatment on the association between weight gain and the development of CKD, and to study to effects of obesity and weight changes on the risk of [end-stage renal disease] or mortality in Asian patients with diabetes and advanced-stage CKD.” – by Amber Cox
Disclosure: The researchers reports no relevant financial disclosures.
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