Metabolic Phenotypes and Chronic Kidney Disease: A Cross-Sectional Assessment of Patients from a Large Federally Qualified Health Center

Abstract

The purpose of this study is to determine if renal function varies by metabolic phenotype. A total of 9599 patients from a large Federally Qualified Health Center (FQHC) were included in the analysis. Metabolic health was classified as the absence of metabolic abnormalities defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Obesity was defined as body mass index >30 kg/m2 and renal health as an estimated glomerular filtration rate (eGFR) >60 mL/min/1.732. Linear and logistic regressions were used to analyze the data. The metabolically healthy overweight (MHO) phenotype had the highest eGFR (104.86 ± 28.76 mL/min/1.72m2) and lowest unadjusted odds of chronic kidney disease (CKD) (OR = 0.46, 95%CI = 0.168, 1.267, p = 0.133), while the metabolically unhealthy normal weight (MUN) phenotype demonstrated the lowest eGFR (91.34 ± 33.28 mL/min/1.72m2) and the highest unadjusted odds of CKD (OR = 3.63, p < 0.0001). After controlling for age, sex, and smoking status, the metabolically unhealthy obese (MUO) (OR = 1.80, 95%CI = 1.08, 3.00, p = 0.024) was the only phenotype with significantly higher odds of CKD as compared to the reference. We demonstrate that the metabolically unhealthy phenotypes have the highest odds of CKD compared to metabolically healthy individuals.

Metabolic Health, Obesity, and Renal Function: 2013–2018 National Health and Nutrition Examination Surveys

“…Kouvari et al reported a large percentage of the MHN phenotype (36.30%) in the relatively homogenous Greek population assessed in the ATTICA cohort study [ 11 ], which is almost double the frequency of the MHN in the present study. Our prior research identified a large percentage of the MUO phenotype (57.79%) in a federally qualified health center in the southern U.S. [ 23 ], which is 1.5 times the proportion that we established here. The sample used in the present study is representative of the entire U.S. population and therefore consists of greater racial and ethnic diversity than the study by Kouvai et al as well as greater socioeconomic and geographic diversity than our prior study.…”

“…Our primary outcomes indicate that the strictly defined MUN phenotype accounted for the largest proportion of the U.S. population, whereas the MHO phenotype accounted for the smallest. In previous studies using the same strict definition of metabolic health, the MUN phenotype varied from 35–45% of the population, and the MHO phenotype ranged from 2.5–5.5% of the population, on average [ 11 , 12 , 23 , 34 ]. In the present study, the proportions of the “intriguing” phenotypes fall within the purviews of prior research.…”

“…These findings persisted across multiple definitions of metabolic health ranging from the strict definition to the standard definition of MetS, demonstrating that one metabolic risk factor may be similarly indicative of renal dysfunction as two or three risk factors but that CKD status was more highly dependent upon ACR than eGFR. The MUN phenotype, while not typically perceived as high risk [ 10 ], has been correlated with adverse health outcomes, such as poor renal function [ 23 ], type 2 diabetes, cardiovascular events, and mortality [ 35 ]. In our study as well as previously reported findings [ 17 , 23 ], the MUN phenotype was correlated with older age.…”

“…The MUN phenotype, while not typically perceived as high risk [ 10 ], has been correlated with adverse health outcomes, such as poor renal function [ 23 ], type 2 diabetes, cardiovascular events, and mortality [ 35 ]. In our study as well as previously reported findings [ 17 , 23 ], the MUN phenotype was correlated with older age. CKD has also been reported to be more common in individuals of older age [ 7 ], though this finding may be due to the prolonged presence of metabolic risk factors rather than age itself.…”

“…This rationale is based on the notion that individuals with hyperglycemia, dyslipidemia, and/or hypertension cannot be considered “healthy” and therefore should not be classified as such [ 21 ]. Several large studies [ 13 , 14 , 22 ] have previously used this definition, and several more [ 11 , 12 , 23 ] have adopted it since it was first proposed by Lavie et al…”