Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes

Hung, Chi‐Chih; Yu, Pei-Hua; Niu, Sheng‐Wen; Kuo, I‐Ching; Lee, Jia-Jung; Shen, Feng‐Ching; Chang, Jer‐Ming; Hwang, Shang‐Jyh

doi:10.3390/jcm11102787

Cited by 10 publications

(12 citation statements)

References 50 publications

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“…demonstrated that high BMI was associated with CKD progression in patients with CKD stage 3 but not in stage 4 38 . Our previous study also showed a similar result 17 . Thus, one study from Taiwan found that the impact of MetS in CKD progression became insignificant in patients with stage 4–5 CKD.…”

Section: Discussionsupporting

confidence: 66%

“…The study conducted by Pammer et al, 13 Our previous study also showed a similar result. 17 Thus, one study from Taiwan found that the impact of MetS in CKD progression became insignificant in patients with stage 4-5 CKD. They interpreted the result as a paradoxical phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…Obesity or central obesity is the main component of MetS. Recently, we demonstrated that obesity paradox is not only for mortality but also for renal outcome 16,17 . High body mass index or high waist circumference was not associated with renal outcome in patients with advanced CKD 17 .…”

Section: Introductionmentioning

confidence: 86%

“…Recently, we demonstrated that obesity paradox is not only for mortality but also for renal outcome 16,17 . High body mass index or high waist circumference was not associated with renal outcome in patients with advanced CKD 17 . One study also suggested that MetS was not a risk factor for CKD progression in patients with CKD stage 4 and 5 12 .…”

Section: Introductionmentioning

confidence: 98%

“…16,17 High body mass index or high waist circumference was not associated with renal outcome in patients with advanced CKD. 17 One study also suggested that MetS was not a risk factor for CKD progression in patients with CKD stage 4 and 5. 12 Thus, whether there is a MetS paradox should be carefully studied.…”

mentioning

confidence: 97%

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High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1–4: The ICKD database

Lin

Chang

Niu

et al. 2023

Diabetes Metabolism Res

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Aims: To investigate whether metabolic syndrome (MetS) could predict renal outcome in patients with established chronic kidney disease (CKD). Materials and Methods:We enroled 2500 patients with CKD stage 1-4 from the Integrated CKD care programme, Kaohsiung for delaying Dialysis (ICKD) prospective observational study. 66.9% and 49.2% patients had MetS and diabetes (DM), respectively. We accessed three clinical outcomes, including all-cause mortality, RRT, and 50% decline in estimated glomerular filtration rate events. Results:The MetS score was positively associated with proteinuria, inflammation, and nutrition markers. In fully adjusted Cox regression, the hazard ratio (HR) (95% confidence interval) of MetS for composite renal outcome (renal replacement therapy, and 50% decline of renal function) in the DM and non-DM subgroups was 1.56 (1.15-2.12) and 1.31 (1.02-1.70), respectively, while that for all-cause mortality was 1.00 (0.71-1.40) and 1.27 (0.92-1.74). Blood pressure is the most important component of MetS for renal outcomes. In the 2 by 2 matrix, compared with the non-DM/non-MetS group, the DM/MetS group (HR: 1.62 (1.31-2.02)) and the non-DM/MetS group (HR: 1.33 (1.05-1.69)) had higher risks for composite renal outcome, whereas the DM/MetS group had higher risk for all-cause mortality (HR:1.43 (1.09-1.88)). Conclusions: MetS could predict renal outcome in patients withCKD stage 1-4 independent of DM. K E Y W O R D S chronic kidney disease, diabetes mellitus, metabolic syndrome, renal outcomes 1 | INTRODUCTION Metabolic syndrome (MetS) is a cluster of medical conditions, including hypertension (HTN), impaired glucose tolerance, central obesity, and dyslipidaemia. 1 MetS increments the risk of diabetes (DM), cardiovascular disease, and chronic kidney disease (CKD) 2 and is the trigger of cardiorenal metabolic disease. Patients with MetS may progress from normoglycaemia to overt DM resulting from a gradual β-cell function decline. DM is one of the most relevant risk factors for both heart failure and end-stage renal disease (ESRD) and

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 97%

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High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1–4: The ICKD database

Lin

Chang

Niu

et al. 2023

Diabetes Metabolism Res

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Approaches to patients with obesity and CKD: focus on nutrition and surgery

Bellizzi,

Annunziata,

Albanese

et al. 2024

Clinical Kidney Journal

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Obesity is recognized as a public health challenge. During the last three decades, the global age-standardized prevalence increased from 8.8% to 18.5% in women and from 4.8% to 14.0% in men, with an absolute current number of 878 million obese subjects. Obesity significantly increases per se the risk of developing disability and chronic diseases, including chronic kidney disease (CKD). Specifically, obesity acts as a major, modifiable cause of CKD onset and progression toward kidney failure; as such, it is considered by the International Society of Nephrology a major health priority. This review analyses the effectiveness, safety and practicability of non-pharmacological anti-obesity interventions in CKD as the different patient phenotypes that may take advantage of personalized approaches.

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Mortality and Renal Outcomes Are Impacted by Obesity in Cardiorenal Metabolic Disease but Not in People with Concomitant Diabetes Mellitus

Al-Chalabi,

Chinnadurai,

Kalra

et al. 2023

Cardiorenal Med

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Introduction: Mounting evidence in the literature describes a reverse association whereby obesity may have a protective effect on mortality – the “obesity paradox”. Due to the significant overlap between elements of cardiorenal metabolic disease, we examined the effects of obesity on outcomes in a cohort of patients with non-dialysis CKD (ND-CKD) by grouping patients according to their level of cardiometabolic co-morbidity to reduce the risk of bias. Methods: This study was undertaken on all patients with a documented body mass index (BMI) in the Salford Kidney Study database from October 2002 until December 2016. Patients were grouped according to their BMI into normal weight, overweight and obese, and also according to their level of co-morbidity into 4 groups: group 1 had CKD only; group 2 had CKD and heart failure (HF); group 3 had CKD and DM; and group 4 had CKD, DM, and HF. Univariate and multivariate Cox regression analyses were performed. Results: A total of 2416 patients were included in the analysis. The median age was 67.3 years, 61.8% were male, and 96.4% were Caucasian. Obesity was associated with a lower incidence of combined outcomes in patients with ND-CKD who did not have DM (HR 0.74; p=<0.001 and HR 0.48; p=0.008 for CKD alone and CKD+HF groups, respectively). This protective effect remained significant after correcting for major factors. In patients with ND-CKD and DM, there was no difference in ACM between the normal weight group and the obesity groups. Conclusion: Obesity may be protective against adverse outcomes only in groups 1 (CKD alone) and group 2 (CKD + HF). This ‘protective’ effect was not seen in patients who had concomitant diabetes. These data suggest that diabetes is a potent predictor of adverse outcomes irrespective of BMI, however, in patients without diabetes, obesity may play a protective role.

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Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes

Cited by 10 publications

References 50 publications

High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1–4: The ICKD database

High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1–4: The ICKD database

Approaches to patients with obesity and CKD: focus on nutrition and surgery

Mortality and Renal Outcomes Are Impacted by Obesity in Cardiorenal Metabolic Disease but Not in People with Concomitant Diabetes Mellitus

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