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Increasing BMI raises risk for major renal events in type 2 diabetes
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Adults with type 2 diabetes and overweight or obesity are more likely to experience a major renal event over 5 years, including new microalbuminuria, end-stage renal disease or renal death, as BMI increases vs. similar adults of normal weight, according to findings published in Nutrition and Diabetes.
“Most reported observational studies have found positive associations between being overweight or obese and kidney outcomes (which include development of CKD, rapid changes in kidney function or ESRD),” Kamel Mohammedi, MD, PhD, of The George Institute for Global Health at the University of Sydney, and colleagues wrote. “However, few have been large enough to compare people with and without diabetes reliably, and there remains some uncertainty in people with diabetes as to whether higher body mass index increases risk of developing macroalbuminuria, and whether BMI–CKD associations are mediated through differences in renal risk factors affected by adiposity.”
Mohammedi and colleagues analyzed data from 10,537 participants with type 2 diabetes and normal weight, overweight or obesity participating in ADVANCE, a randomized controlled trial investigating the effects of intensive glucose management (58% men; mean age, 66 years; mean diabetes duration, 8 years). Researchers stratified the cohort by five baseline BMI categories: normal weight (18.5 to < 25 kg/m²; n = 2,894), overweight (25 to < 30 kg/m²; n = 4,340), obesity grade 1 (30 to < 35 kg/m²; n = 2,265), obesity grade 2 (35 to < 40 kg/m²; n = 744) and obesity grade 3 ( 40 kg/m²; n = 294).
The composite outcome of major renal event was defined as the development of new macroalbuminuria, a doubling of serum creatinine, ESRD or renal death. These outcomes and development of new microalbuminuria were considered individually as secondary endpoints.
During 5 years of follow-up, 487 participants (4.6%) experienced a major renal event. Researchers observed that risk for experiencing a major renal event grew with increasing BMI. Major renal events occurred in 144 participants (5%) with normal weight, 181 (4.2%) with overweight, 96 (4.2%) with obesity grade 1, 43 (5.8%) with obesity grade 2 and 23 (7.8%) with obesity grade 3.
Compared with participants with normal weight, the adjusted HR was 0.91 (95% CI, 0.72-1.15) for participants with overweight, 1.03 (95% CI, 0.77-1.37) for obesity grade 1, 1.42 (95% CI, 0.98-2.07) for obesity grade 2 and 2.16 (95% CI, 1.34-3.48) for obesity grade 3 (P for trend = .006).
For each additional unit of BMI more than 25 kg/m², the risk for major renal events increased by 4% (P for trend = .002), according to the researchers. Comparable results were observed with the risks for secondary endpoints, they noted.
Findings persisted in subgroup analyses stratified by interventions, including intensive vs. standard glucose control and perindopril-indapamide intervention vs. placebo.
“Our findings encourage comprehensive and motivated weight-loss programs for improving the prevention of the development and progression of kidney complications in patients with both type 2 diabetes and obesity,” the researchers wrote. – by Regina Schaffer
Disclosures: Mohammedi reports he has received personal fees from Novo Nordisk. Please see the study for the other authors’ relevant financial disclosures.
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