A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population

Abstract

Obesity and chronic kidney disease (CKD) are public health priorities that share core pathophysiological mechanisms. However, whether high body mass index (BMI) increases risk of CKD de novo remains ill-defined. To evaluate the role of BMI in predicting CKD onset in the general adult population, we performed a systematic review and meta-analysis of PubMed and ISI Web of Science databases articles published between January 2000 and August 2016 without language restriction. We selected studies in adult individuals from a general population with normal renal function at baseline that reported the risk of low estimated glomerular filtration (eGFR) (under 60 mL/min/1.73m) and/or albuminuria (1+ at dipstick or an albumin creatinine ratio of 3.4 mg/mmol or more) as hazard ratio, odds ratio or relative risk related to obesity, overweight, or BMI as continuous value. A total of 39 cohorts covering 630, 677 participants with a mean follow-up of 6.8 years were selected. Obesity increased the relative risk, 95% confidence interval and heterogeneity (I) of developing low eGFR (1.28, 1.07-1.54, [I: 95.0%]) and albuminuria (1.51, 1.36-1.67, [I: 62.7%]). Increase of BMI unit was also associated with higher risk of low eGFR (1.02, 1.01-1.03, [I: 24.3%]) and albuminuria (1.02, 1.00-1.04, [I: 0%]). Conversely, overweight did not predict onset of either low eGFR (1.06, 0.94-1.21, [I: 50.0%]) or albuminuria (1.24, 0.98-1.58, [I: 49.4%]). Thus, a high BMI predicts onset of albuminuria without kidney failure (CKD stages 1-2) as well as CKD stages 3 and higher, the effect being significant only in obese individuals. Hence, our findings may have implications to improve risk stratification and recommendations on body weight control in the general population.

Body fat distribution is more predictive of all‐cause mortality than overall adiposity

“…Obesity has been thought to have a negative effect on mortality because of its close association with various metabolic diseases . However, recent studies have consistently suggested that body fat distribution may be more important than overall adiposity .…”

“…Obesity has been thought to have a negative effect on mortality 6 because of its close association with various metabolic diseases. [3][4][5] However, recent studies have consistently suggested that body fat distribution may be more important than overall adiposity. [14][15][16][17] There have been several efforts to differentiate body fat by its deposited location to discern the clinical impact of body fat distribution on mortality, including skin fold measurements, [33][34][35] bio-impedance, 36 sonographic depth, 37 and dual-energy X-ray absorptiometry.…”

“…The prevalence of obesity is rapidly increasing worldwide . Obesity has been shown to be an important risk factor for diabetes, cardiovascular disease, chronic kidney disease, and mortality . However, the relationship between obesity and mortality is complex.…”

Preventive Nephrology: The Role of Obesity in Different Stages of Chronic Kidney Disease

“…In the general population, obesity (BMI > 30) increases the risk of CKD, onset of albuminuria in CKD stages 1-2 as well as progression to CKD stages 3 and higher in the general population [18]. The course of CKD may be modulated by different causes of reduced kidney mass, genetic aspects, and metabolic phenotype.…”

Body mass index and risk of sick leave: A systematic review and meta‐analysis

“…Obesity is associated with several important diseases that include type 2 diabetes, heart disease, stroke, asthma, cancer, chronic kidney disease, liver disease, all‐cause mortality, sciatica, low back pain, carpal tunnel syndrome . High BMI is also associated with a variety of psychological and neurological disorders, such as dementia, Alzheimer, suicide and other mental disorders .…”