Obesity, Metabolic Abnormality, and Progression of CKD

Yun, Hae‐Ryong; Kim, Hyoungnae; Park, Sun-Hee; Chang, Tae Ik; Yoo, Tae‐Hyun; Kang, Shin-Wook; Choi, Kyu Hun; Sung, Suah; Kim, Soo Wan; Lee, Joongyub; Oh, Kook‐Hwan; Ahn, Curie; Han, Seung Hyeok; Park, Seohyun; Jhee, Jong Hyun; Kee, Youn Kyung; Chae, Dong Wan; Chin, Ho Jun; Park, Hayne Cho; Lee, Kyu‐Beck; Kim, Yong Soo; Chung, Wookyung; Hwang, Young-Hwan; Kim, Yeong Hoon; Kang, Sun Woo

doi:10.1053/j.ajkd.2018.02.362

Cited by 117 publications

(66 citation statements)

References 44 publications

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“…The results clearly suggest that obesity defined by anthropometric measurement has its limitation in the predictability of HRQoL in CKD patients, and emphasize the impact of metabolic status based on the laboratory findings. To summarize, the findings from the current study and others suggest that obesity per se might not impair HRQoL in CKD population, and that, rather, inflammation or metabolic abnormalities would be truly associated with low HRQoL, both of which conditions are prevalent and easily accompanied in patients with CKD 13,38 .…”

Section: Discussionsupporting

confidence: 46%

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Chronic kidney disease attenuates the impact of obesity on quality of life

Suh

Choi

Kim

et al. 2020

Sci Rep

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the impact of obesity on health-related quality of life (HRQoL) in chronic kidney disease (cKD) population has not been elucidated, despite the impairment of HRQoL in the obese among general population. We hypothesized that the impact of obesity on HRQoL might be confounded by impaired renal function in cKD population, and that cKD would attenuate the impact of obesity on HRQoL. to compare the impact of obesity on HRQoL according to kidney function, 17,001 subjects from Korea National Health and Nutrition Examination Survey (2008-2011) were categorized by estimated glomerular filtration rate (eGFR), as follows: group 1, eGFR ≥ 90 mL/min/1.73 m 2 ; group 2, eGFR of 60-89 mL/min/1.73 m 2 ; group 3, eGFR < 60 mL/min/1.73 m 2 . the association between obesity parameters (body mass index, waist circumference and, truncal fat mass) and HRQoL parameters (eQ-5D index and EQ-VAS) were cross-sectionally analyzed. Despite robust correlations between obesity parameters and low EQ-5D index or EQ-VAS in general population, no significant association was observed in group 3 population. Impact of obesity on HRQoL in CKD population was only limitedly observed in the mobility domain of EQ-5D, as mobility limitation was associated with increased body mass index or waist circumference regardless of kidney function. therefore, the impact of obesity on HRQoL seems significantly attenuated in CKD population, suggesting that the risk of obesity should not be over-estimated in patients with cKD, especially with respect to HRQoL.Obesity imposes a great burden on the public health globally, as it increases the risk of type 2 diabetes mellitus, cardiovascular disease, cerebrovascular accident, and malignancy, and is subsequently associated with high cardiovascular and all-cause mortalities 1-3 . Especially, central obesity, defined by waist circumference (WC) or WC to height ratio, more precisely predicts cardiovascular risk factors than body mass index (BMI) does 4 . The concept, metabolically healthy obesity, introduced broad spectral phenotypes of obesity and emphasized the importance of anatomical distribution of body fat 5 . Indeed, various indices from direct measurement of regional fat mass 6 or from calculation of more than 2 anatomical fat deposits 7 have proved their superiority over BMI on estimating the risk of cardiovascular events. On the basis of conceptual advances, novel links between obesity and human diseases are now being uncovered.Kidney is a target of obesity 8 , as evidences suggest that conditions related to obesity, such as insulin resistance 9 , up-regulation of leptin 10 , or down-regulation of adiponectin 11 , promote glomerular injury and albuminuria, leading to the decline of kidney function. Nevertheless, clinical studies have not concluded the impact of obesity on CKD progression. A cohort study including more than 450,000 nondialysis-dependent subjects reported U-shaped association of BMI and clinical outcomes with the best in overweight and mildly obese patients, rather than in patients with ideal body weig...

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Section: Discussionsupporting

confidence: 46%

“…Considering the contribution of obesity to CKD progression 13 , loss of correlation between obesity and HRQoL in CKD population was unexpected. Of interest is that a similar trend has been reported from the studies of serum uric acid level in CKD population 29,30 .…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease attenuates the impact of obesity on quality of life

Suh

Choi

Kim

et al. 2020

Sci Rep

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“…The influence of obesity on the development of CKD remains controversial. A large prospective observational cohort study in Korea reported that obesity was associated significantly with a 1.41-fold increase in the risk for adverse changes in renal function [16], whereas another large-scale cohort study in a CKD population with diabetes showed that the prevalence of metabolic syndrome, but not obesity, was associated significantly with CKD [17]. The influence of the metabolically healthy obese patients may be a reason for this discrepancy.…”

Section: Discussionmentioning

confidence: 99%

FIB-4 Index and Diabetes Mellitus Are Associated with Chronic Kidney Disease in Japanese Patients with Non-Alcoholic Fatty Liver Disease

Seko

Yano

Takahashi

et al. 2019

IJMS

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Non-alcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). The aim of this retrospective study was to determine the risk factors for progression of CKD in patients with biopsy-proven NAFLD including patatin-like phospholipase domain containing 3 (PNPLA3) polymorphism. A total of 344 patients with biopsy-proven NAFLD were enrolled consecutively in this study. Multivariate analysis identified males (odds ratio (OR) 5.46), age (per 1 year, OR 1.07), and FIB-4 index (≥1.30, OR 3.85) as factors associated with CKD. Of the 154 patients with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min, 30 had a deterioration in CKD stage and 15 developed CKD after 3 years. Multivariate analysis identified diabetes mellitus (OR 2.44) as a risk factor for deterioration in CKD stage, while diabetes mellitus (OR 21.54) and baseline eGFR (per 1 mL/min OR 0.88) were risk factors for development of CKD. PNPLA3 did not affect the change in eGFR. In NAFLD patients, a high FIB-4 index was associated with CKD to increases in the index linked to reductions in eGFR. In order to prevent development of CKD, an appropriate therapy focusing on renal function is needed for NAFLD patients, especially those with diabetes.

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“…Reports from other studies investigating the effects of metabolic syndrome on eGFR have not included details about follow-up duration or changes in metabolic syndrome over time. 6,7,[20][21][22][23] The Japanese guidelines recommend that living kidney donors are assessed regularly, and their health and comorbidities must be well managed. 6,7,14,15 Without detailed investigations into donor management and treatment adherence during follow-up, evaluation of ESRD risk, mortality, and renal function cannot provide insight into the true effects of PCs in the context of kidney donation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Comorbidities and Outcomes of Medically Complex Living Kidney Donors

Hiramitsu

Tomosugi

Futamura

et al. 2020

Kidney International Reports

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Introduction: Recent reports have described an increased risk of renal disease in living kidney donors compared with the general population. However, these reports do not detail the outcomes of medically complex living donors (MCLDs) with preoperative comorbidities (PCs), such as hypertension, dyslipidemia, glucose intolerance, and obesity. Analysis of living donors with end-stage renal disease (ESRD) has shown that these PCs may contribute significantly to the development of ESRD. We aimed to evaluate the effect of PCs on postoperative renal function and mortality in MCLDs. Methods: Between January 2008 and December 2016, 807 living-donor kidney transplants were performed in our unit. Of these, 802 donors completed postoperative follow-up of >5 months. Donors were stratified into 4 groups based on the number of PCs present: healthy living donors (HLDs) with no PCs (n ¼ 214) or MCLDs with 1 PC (n ¼ 302), 2 PCs (n ¼ 196), or 3 PCs (n ¼ 90) (denoted MCLD [PC 1], MCLD [PC 2], or MCLD [PC 3], respectively). We compared pathology observation data from baseline biopsy, postoperative estimated glomerular filtration rate (eGFR), postoperative urinary protein concentration, and mortality between HLD and MCLD groups. Results: Interstitial fibrosis, tubular atrophy, glomerulosclerosis, and arteriolosclerosis were more frequent in MCLDs (PC 3) than in HLDs. No significant differences were identified between HLDs and MCLDs in terms of postoperative eGFR and short-term mortality. Overt proteinuria and ESRD were not observed. Conclusions: Appropriate postdonation management of MCLDs with PCs may result in similar outcomes as for HLDs.

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Obesity, Metabolic Abnormality, and Progression of CKD

Cited by 117 publications

References 44 publications

Chronic kidney disease attenuates the impact of obesity on quality of life

Chronic kidney disease attenuates the impact of obesity on quality of life

FIB-4 Index and Diabetes Mellitus Are Associated with Chronic Kidney Disease in Japanese Patients with Non-Alcoholic Fatty Liver Disease

Preoperative Comorbidities and Outcomes of Medically Complex Living Kidney Donors

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