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Obesity with or without metabolic abnormality accelerates CKD progression
Patients with obesity had an increased risk for chronic kidney disease progression, regardless of whether they also had metabolic abnormality, according to a published study.
“Recent studies have identified a unique subtype of obesity called metabolically healthy obesity, which has distinct features of low metabolic burden such as better lipid and inflammatory profiles, lower insulin resistance, and lower blood pressure than traditional obesity,” Hae-Ryong Yun, MD, of the Institute of Kidney Disease Research at Yonsei University in South Korea, and colleagues wrote. “Notably, obese persons without metabolic disturbances were reported to have comparable risk for cardiovascular mortality as nonobese persons without metabolic disturbances. This finding led us to assume that obesity itself can have an unfavorable impact on kidney function, and metabolic disturbances can modify the relationship between obesity and renal outcomes in patients with CKD.”
Researchers sought to examine the association between obesity, metabolic abnormality and kidney disease progression, as well as to explore whether obesity without metabolic disturbances is adversely associated with renal outcomes. To do this, a prospective observational cohort study of 1,940 patients with CKD stages 1 to 5 was conducted.
Researchers first determined whether patients had obesity (defined as BMI of at least 25 kg/m2) or metabolic abnormality. A patient was considered to have metabolic abnormality if they had three or more of the following: hypertension, fasting plasma glucose level of more than 125 mg/dL or the presence of type 2 diabetes, triglyceride level greater than 150 mg/dL or use of lipid-lowering drugs, HDL-cholesterol level of 40 mg/dL or less in men or 50 mg/dL in women or high-sensitivity C-reactive protein greater than 1 mg/L.
The primary outcome of the study was a composite of a 50% decline in eGFR from baseline or ESKD, and patients were followed for a mean of 3.1 years.
During this time, the primary outcome occurred in 20.4% of patients.
Researchers found that, after adjusting for confounding factors, obesity was associated with a 1.41-fold increased risk for adverse renal outcomes. For those with metabolic abnormality, this risk was 1.38-fold.
Patients with both obesity and metabolic abnormality had a greater risk for CKD progression than those who had neither condition (HR = 1.53). Furthermore, those with obesity but not metabolic abnormality also had a higher rate of CKD progression (HR = 1.97).
“We demonstrated that both obesity and metabolic abnormality were associated with adverse renal outcomes in patients with CKD,” the researchers wrote. “Moreover, our findings raise doubts about the previous notion that obese persons without metabolic abnormality are healthy because we found that they also have higher risk for kidney disease progression. This can be partly explained by the lower adiponectin levels and higher left ventricular mass index and protein excretion in these patients. Further long-term studies are required to confirm our findings.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.