Normal weight and waist obesity indicated by increased total body fat associated with all-cause mortality in stage 3–5 chronic kidney disease

Shen, Feng‐Ching; Chen, Mei-En; Wu, Wen Shu; Kuo, I‐Ching; Niu, Sheng‐Wen; Lee, Jia-Jung; Hung, Chi‐Chih; Chang, Jer‐Ming; Hwang, Shang‐Jyh

doi:10.3389/fnut.2022.982519

Cited by 8 publications

(8 citation statements)

References 67 publications

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“…In our cohort, PBF had a protective effect on prognosis among people with CKD stages 3–5 and no significant results were found in addition to TC. These results corroborate research which supports obesity paradox [ 28 ]. Furthermore, PBF showed more robust effects than TC.…”

Section: Discussionsupporting

confidence: 92%

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

Chen,

Xiao,

Chen

et al. 2024

Lipids Health Dis

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Background Lipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis. Purpose Explore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3–5. Methods This is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3–5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m2, or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness.. Results 255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m2. Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis.. Conclusion Comprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3–5.

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Section: Discussionsupporting

confidence: 92%

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

Chen,

Xiao,

Chen

et al. 2024

Lipids Health Dis

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show abstract

“…In our cohort, PBF had a protective effect on prognosis among people with CKD stages 3-5 and no signi cant results were found in addition to TC. These results corroborate research which supports obesity paradox [27]. Furthermore, PBF showed more robust effects than TC.…”

Section: Sensitivity Analysissupporting

confidence: 91%

Composite Lipid Parameters are Optimal in Predicting Chronic Kidney Disease Prognosis

Chen,

Xiao,

Chen

et al. 2023

Preprint

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Background Lipid management in clinic is critical to the prevention and treatment of CKD, while the manifestations of fat metabolism vary in type and have flexible correlations with CKD prognosis. Purpose Explore correlations between the widely used indicators of lipid metabolism in clinic and CKD prognosis; provide a reference for lipid management and treatment among non-dialysis CKD stages 3–5. Methods This is a retrospective cohort study utilizing the SMP-CKD database of 794 individuals with CKD stages 3–5. Variables with P < 0.10 in univariate Poisson models were induced to construct several timescale-based Poisson models with a stepwise regression according to lipid manifestation categories. We selected the best model via AIC, AUC and ROC and confirmed the independent relative exposures via RRs (95% CI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness. Results 255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.35 [48.50, 66.69] years with a median eGFR of 33.68 [17.55, 47.81] ml/min/1.73 m2. The fully adjusted category-based Poisson Model 4 in Dataset 5 had the largest AUC (0.717 [0.684, 0.751]) with P for ROC < 0.05. TC (1.158 [1.056, 1.271], P = 0.002) and PBF (0.948 [0.906, 0.992], P = 0.021) were significant factors of composite outcome and no manual measurements had any statistically significance. The

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“…One possible reason for this discrepancy is the presence of protective nutritional effects of weight gain in patients with CKD 37) . In these patients, obesity is associated with a superior prognosis, which is referred to as the "obesity paradox" [37][38][39][40] . In addition, the adipose tissue may resist the effects of diseases characterized by catabolism [41][42][43][44] , such as CKD.…”

Section: Discussionmentioning

confidence: 99%

Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease

Okamura,

Tanaka,

Kitamura

et al. 2024

JAT

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Aims: Weight changes from a young age are known to be associated with poor life outcomes in the general population. However, little is known about the association between weight change from a young age and life expectancy in patients with chronic kidney disease (CKD).Methods: Data of 2,806 nondialysis CKD patients who participated in the Fukuoka Kidney Disease Registry (FKR) Study, a multicenter observational study, were analyzed. The primary outcome was all-cause death, whereas the secondary outcome was cardiovascular mortality. The covariate of interest was weight change, defined as the difference between body weight at study enrollment and at 20 years old. Cox proportional-hazards models were used to estimate the risks of mortality for participants with weight changes of ≥ 5 or ＜5 kg compared with those with stable weights.Results: During the 5-year observation period, 243 participants died from all causes and 62 from cardiovascular disease. The risk of all-cause mortality in the weight-loss group was significantly higher than that in the stableweight group (multivariable-adjusted hazard ratio, 2.11; 95% confidence interval [CI], 1.52-2.93). Conversely, the risk of cardiovascular mortality in the weight-loss group was significantly higher than that in the stableweight group (multivariable-adjusted hazard ratio, 2.48; 95% CI, 1.32-4.64). However, no significant association was observed between weight gain and the risks of all-cause and cardiovascular mortalities. Conclusion:Weight loss from 20 years of age was found to be associated with higher risks of all-cause and cardiovascular mortalities in patients with CKD.

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Normal weight and waist obesity indicated by increased total body fat associated with all-cause mortality in stage 3–5 chronic kidney disease

Cited by 8 publications

References 67 publications

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

Composite Lipid Parameters are Optimal in Predicting Chronic Kidney Disease Prognosis

Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease

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