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Obesity increases risk for chronic kidney disease, but not in diabetes
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Taiwanese adults with obesity have a 30% increased risk for developing chronic kidney disease when compared with the normal-weight population; however, this association was not observed in people with diabetes, according to recently published findings.
Yun-Ju Lai, MD, PhD, of the division of endocrinology and metabolism at Puli Branch of Taichung Veterans General Hospital in Nantou, Taiwan, and colleagues analyzed data from 45,012 adults free of CKD at baseline participating in the 2001, 2005 and 2009 waves of the National Health Interview Survey in Taiwan (49.91% women; mean age, 42 years). The national, cross-sectional survey included an in-person interview; dataset included weight, height, health behaviors and income. BMI was classified as underweight (BMI of 18.5 kg/m² or less), normal weight (BMI between 18.5 kg/m² and 23.9 kg/m²), overweight (BMI between 24 kg/m² and 26.9 kg/m²) and obesity (BMI of at least 27 kg/m²). Researchers linked survey data with claims data from the Taiwan National Health Insurance database for 2000 through 2013, and used Cox proportional hazard models to assess the association between incident CKD and BMI, considering death as a competing risk event.
Within the cohort, 23.64% had overweight, and 15.82% had obesity. Over 374,254 person-years of follow-up, 5.01% and 6.87%, respectively, developed new-onset CKD.
After adjustment for demographics and comorbidities, those with obesity had a 32% increased risk for developing CKD when compared with normal weight participants (HR = 1.32; 95% CI, 1.17-1.49). Using the linear trend test to determine the exposure-response relationship of BMI and incidence of CKD, researchers found that the risk of incident CKD increased as BMI increased (HR = 1.14; 95% CI, 1.07-1.2; P < .01 for trend).
The researchers also observed a significant interaction between BMI and diabetes (P < .01 for interaction) and between BMI and hypertension (P = .02 for interaction) on the risk for incident CKD, and they performed stratified analyses.
“Interestingly, obesity was significantly associated with an increased risk of incident CKD in all subgroups, except in people with diabetes,” the researchers wrote.
The researchers further noted that people with diabetes and overweight had decreased risk for CKD when compared with those with normal weight.
“Obesity-related renal disease and diabetic nephropathy share some common mechanisms and pathophysiology, such as activation of the renin-angiotensin-aldosterone system and increased inflammatory cytokine production,” the researchers wrote. “However, the interaction between obesity and diabetes is not fully understood. Further studies are warranted to investigate whether obesity is dependent or independent of type 2 diabetes in the development of CKD, as well as the mechanisms of their potential interaction.
“Maintaining an ideal weight is important for preventing the burden of CKD,” the researchers wrote, adding that keeping a healthy weight depends on establishing healthy eating habits and engaging in regular exercise. – by Regina Schaffer
Disclosures: Endocrine Today was unable to determine relevant financial disclosures.
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