BMI loss, serum albumin loss correlate with mortality risk in patients with CKD, obesity
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Key takeaways:
- BMI loss with a stable fat-free mass correlates with lower death risk than BMI loss with sustained fat-free mass loss.
- The rate of weight loss and concurrent trends can help researchers understand mortality.
Patients with chronic kidney disease and obesity may be at a higher risk for death when experiencing BMI loss at the same time as serum albumin or fat-free mass loss, according to data published in Kidney International Reports.
“It may be possible to distinguish healthy [vs.] high-risk weight loss by examining concurrent trajectories of clinical variables for evidence of increased physiologic resilience or vulnerability, respectively,” Meera N. Harhay, MD, from Drexel University College of Medicine, and colleagues wrote. “The ability to identify healthy and high-risk weight loss phenotypes among adults with CKD and obesity will improve clinical surveillance of weight loss and the design of future weight loss interventions. The goal of this study was to identify distinct, multidimensional obesity weight loss phenotypes in CKD and [end-stage kidney disease] ESKD.”
In an analysis of the CRIC Study, researchers examined data for 2,831 patients with CKD and obesity. Patients had a median baseline BMI of 35.6 kg/m2. Additionally, 82% reported they were trying to control or lose weight at baseline.
With percentage changes in BMI, change in systolic blood pressure (SBP) and change in serum albumin serving as the exposures, researchers considered weight loss the primary outcome. Using a joint multivariate latent class model with six BMI classes, researchers determined trajectories of BMI, albumin and SBP. A secondary analysis was then conducted with BMI and fat-free mass (FFM).
Analyses revealed the 5-year cumulative incidence of mortality was 6.8% in class 6 patients and 1.5% in class 3 patients. Overall, patients in class 6 showed the highest mortality, had early BMI loss and serum albumin decline and late SBP increase.
“Specifically, we identified that a pattern of rapid weight loss with relatively small changes in SBP and decreases in serum albumin was associated with a nearly threefold higher risk of death as compared to a pattern characterized by less rapid weight loss, albumin increase, and decline in SBP,” Harhay and colleagues wrote.
Following the secondary analysis, researchers determined that classes characterized by significant BMI and FFM loss correlated with the highest mortality risk.
“In our study, we found that the weight loss phenotypes were associated with differences in mortality independent of self-reported intentions to control or lose weight. Our secondary analysis suggests that differences in the retention of lean body mass while losing weight might be a key indicator of healthy vs. high-risk weight loss among adults with CKD and obesity,” Harhay and colleagues wrote. They added, “[W]e showed that the rate and extent of weight loss and concurrent trends of nutritional, hemodynamic and body composition indicators are important to understand long-term mortality risks. Although many such individuals have important motivations to lose weight, weight loss attempts should be monitored clinically and those with rapid weight loss should be assessed for signs of worsening physiologic vulnerability.”
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