The risk of chronic kidney disease in a metabolically healthy obese population

Abstract

Obesity has become an important risk factor for chronic kidney disease (CKD). The metabolically healthy obese (MHO) phenotype refers to obese individuals with a favorable metabolic profile. However, its prognostic value remains controversial and may depend on the health outcome being investigated. To assess this, we examined the risk of MHO phenotype with incident CKD in a Korean population of 41,194 people without CKD. Individuals were stratified by body mass index (cutoff value, 25.0 kg/m(2)) and metabolic health state (assessed using Adult Treatment Panel-III criteria). Incident CKD was defined as a glomerular filtration rate of <60 ml/min per 1.73 m(2) calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Over the median follow-up period of 38.7 months, 356 of the individuals developed incident CKD. Compared with the metabolically healthy nonobese (MHNO) group, the MHO group showed increased risk of incident CKD with a multivariate-adjusted hazard ratio of 1.38 (95% CI, 1.01-1.87). Nonobese but metabolically unhealthy individuals were at an increased risk of incident CKD (multivariate-adjusted hazard ratio, 1.37 (95% CI, 1.02-1.93)) than the MHNO group. Metabolically unhealthy obese individuals were at the highest risk of incident CKD. Thus, a healthy metabolic profile does not protect obese adults from incident CKD. Hence, it is important to consider metabolic health along with obesity when evaluating CKD risk.

Consequences of morbid obesity on the kidney. Where are we going?

“…However, not all MO patients develop ORG, implicating the importance of genetic susceptibility and environmental conditions in its development. Apparently, it seems to be a subgroup of obese patients with a unique phenotype, the metabolically healthy obesity, that does not associate higher risk of incident CKD [24, 25]. Although the incidence of ORG is unknown due to a lack of data in the literature, D'Agathi and co-workers [13, 26] observed an alarming increase in its incidence in a retrospective study of patients with proteinuria or proteinuria and renal failure performed between 1986 and 2000.…”

Visceral Adiposity Index and Lipid Accumulation Product Index: Two Alternate Body Indices to Identify Chronic Kidney Disease among the Rural Population in Northeast China

“…Therefore, prevention and management of CKD seem to be particularly important. Obesity as a focus of growing attention has been associated with CKD, even in the early stage of an impaired kidney [5,6,7]. Classical anthropometric index the body mass index (BMI) has been widely used in obesity studies because of its recognizability [8].…”

Healthy obesity as an intermediate state of risk: a critical review

“…For instance, given obesity's strong link with development of kidney disease (6), several recent studies have examined whether this is also true of healthy obese adults. The risk for both incident kidney disease (77,78) and of end-stage kidney disease is reported to be higher among healthy obese than among healthy normal-weight adults (79) across 3 studies, excess risk again being greatest among unhealthy obese adults in line with patterns observed for type 2 diabetes and cardiovascular outcomes. Given established, albeit complicated, links between BMI and development of several types of common cancer (80,81), it is also worth comparing these risks between healthy obese and healthy normal-weight adults; this has not been done, but a higher risk of cancer-related mortality among healthy obese than among healthy normal-weight adults has been reported in one study (55).…”