Elevated body mass index as a risk factor for chronic kidney disease: current perspectives

Abstract Background and Aims Obesity is a risk factor for chronic kidney disease (CKD), but the effect of reducing body mass index (BMI) on the prevention of CKD is controversial. One of reasons for this disagreement is that part of patients with a BMI decrease may have an unfavourable health status. In such cases, the BMI decrease could be a risk factor for the development of CKD. Therefore, by analysing the data of annual health check-ups, we examined an association between BMI change and CKD development to determine whether BMI reduction helps prevent CKD development. Method We analysed the data of 6,959 subjects who underwent annual health check-ups in both 2013 and 2018. By a multivariate logistic regression analysis, we investigated a relationship between BMI change and CKD development within the 5 years between 2013 and 2018. The percent change in the BMI (ΔBMI) was calculated using the following equation: {(BMI in 2018 − BMI in 2013)/BMI in 2013} ×100. For analyses, we classified the subjects into five groups based on their ΔBMI value: (i) severe BMI decrease (ΔBMI <−2.5%); (ii) moderate BMI decrease (ΔBMI ≥−2.5% but <0%); (iii) maintained BMI (ΔBMI ≥0% but <2.5%); (iv) moderate BMI increase (ΔBMI ≥2.5% but <5%); (v) severe BMI increase (ΔBMI ≥5%). For further analysis, we divided the subjects into non-obesity category (basal BMI <25 Kg/m2) and obesity category (basal BMI ≥25 Kg/m2). Subjects with an estimated glomerular filtration rate <60 mL/min./1.73 m2 were defined as having a CKD. Results After adjusting several covariates, compared with the maintained BMI group, the severe BMI decrease group showed a significantly low risk of CKD development (odds ratio (OR) 0.70, 95% confidence intervals (CI) 0.54-0.91, p <0.01) and the severe BMI increase group had a significantly high risk (OR 1.40, CI 1.08-1.81, p = 0.01). A farther analysis revealed that the OR of CKD development for the severe BMI increase group in the obesity category was higher than that in the non-obesity category (OR 1.75 vs. 1.29). Conclusion In subjects who underwent annual health check-ups, BMI reduction had a significant effect on the prevention of CKD development, whereas an increase in the BMI was a risk factor for CKD development. Moreover, by severe increase in the BMI, obesity subjects showed higher risk of CKD development than non-obesity subjects.

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IMPACT OF ELEVATED BODY MASS INDEX AND CHRONIC KIDNEY DISEASE ON MORTALITY IN PATIENTS WITH PERIPHERAL VASCULAR DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)61448-4 ◽

2011 ◽

Vol 57 (14) ◽

pp. E1448

Author(s):

Aravinda Nanjundappa ◽

Nick DePriest ◽

Waqas Ahmed ◽

Ashwin Bhirud ◽

Robert Dieter ◽

...

Keyword(s):

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Body Mass ◽

Peripheral Vascular ◽

Elevated Body Mass Index

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Body mass index mortality paradox in chronic kidney disease patients with suspected cardiac chest pain.

JCSM Clinical Reports ◽

10.17987/jcsm-cr.v2i1.10 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Jamie Michael O'Driscoll ◽

Adrian Slee ◽

Rajan Sharma

Keyword(s):

Body Mass Index ◽

Chronic Kidney Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Risk Factor ◽

Kidney Disease ◽

Body Mass ◽

All Cause Mortality ◽

The Relationship

Background: Chronic kidney disease (CKD) is a silent clinical condition associated with adverse comorbidity and high cardiovascular disease (CVD) risk. An inverse relationship with body mass index (BMI) and mortality has been demonstrated in hemodialysis patients. However, it is unclear if this risk-factor paradox is evident in non-dialysis CKD patients. The aims of this study were to explore the relationship between, nutritional status, markers of inflammation, autonomic and cardiac function with BMI. Longitudinal follow-up explored the relationship between BMI and all-cause mortality. Methods: 211-consecutive CKD patients referred for dobutamine stress echocardiography to detect or exclude myocardial ischemia were recruited. BMI, albumin, C-reactive protein (CRP) and haemoglobin (Hb) were recorded as markers of nutritional and inflammatory status. Left ventricular ejection fraction (LVEF) and heart rate variability (HRV) as an indicator of cardiac function was recorded. All subjects were followed prospectively until November 2014 and study end-point was all-cause mortality. Results: BMI was inversely associated with CKD status. After covariate adjustment, this association remained. During a mean follow-up period of 3.3±0.9 years there were 35 deaths (17%). BMI was inversely associated with all-cause mortality (HR 0.81, 95% CI 0.71-0.9). Other important independent predictors of mortality were heart rate variability (HR 0.98, 95% CI 0.97-0.99), myocardial ischemia (HR 1.37, 95% CI 1.17-1.81), and albumin (HR 0.86, 95% CI 0.81-0.92). Conclusions: The presence of a body mass index paradox exists in non-dialysis CKD patients. This risk-factor paradox was an independent predictor of all-cause mortality and may have significant clinical implications relevant to screening, assessment and treatment and requires further study.

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