Obesity plus low muscle mass may increase CKD risk in type 2 diabetes
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Sarcopenic obesity may increase the risk for chronic kidney disease among adults with type 2 diabetes, but low muscle mass without obesity was not associated with CKD, according to study results published in Obesity.
“Accumulation of uremic toxins, chronic inflammation, insulin resistance, hormonal imbalance, malnutrition, vitamin D deficiency and oxidative stress contribute to the pathogenesis of sarcopenia in patients with CKD,” Da Hea Seo, MD, from the division of endocrinology and metabolism in the department of internal medicine at Inha University College of Medicine, Incheon, South Korea, and colleagues wrote. “Several cross-sectional studies have shown that both sarcopenia and obesity are associated with a higher prevalence of CKD in the general population.”
Researchers enrolled 3,123 adults with type 2 diabetes (mean age, 56.9 years) with preserved renal function from the Seoul Metabolic Syndrome cohort between 2000 and 2016 at the Huh Diabetes Center in Seoul. All participants were followed for incident CKD for a mean of 8.9 years. Researchers estimated skeletal muscle mass from bioelectrical impedance analysis, and CKD was defined as an estimated glomerular filtration rate of more than 60 mL/min/1.73 m2. Sarcopenic obesity was defined as the coexistence of sarcopenia and abdominal obesity.
During follow-up, 17% of participants developed incident CKD. When divided into sex-specific tertiles based on skeletal muscle mass, there was no association between lower muscle mass and increased incident CKD risk when adjusted for risk factors. Cumulative CKD incidence was significantly higher among participants in the lower tertile (24.7%) compared with the middle (17.3%) and the highest (8.9%) tertiles.
When patients were grouped into quartiles by presence of sarcopenia and obesity, sarcopenic obesity was associated with an increased incident CKD risk (adjusted HR = 1.77; 95% CI, 1.24-2.51; P for trend = .001).
In addition, when sarcopenic obesity was defined with BMI and skeletal muscle mass index, researchers observed a similar association with incident CKD (aHR = 1.39; 95% CI, 1.05-1.84; P for trend = .022). However, this association became insignificant after adjusting for waist circumference.
“Future prospective trials are warranted to better understand the natural course of CKD associated with longitudinal dynamic changes in skeletal muscle mass and waist circumference in patients with type 2 diabetes,” the researchers wrote.
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