The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Obesity is associated with incident chronic kidney disease in individuals with normal renal function

  • Su Hyun Song (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Tae Ryom Oh (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Sang Heon Suh (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Hong Sang Choi (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Chang Seong Kim (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Seong Kwon Ma (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Soo Wan Kim (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Eun Hui Bae (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2023.11.14
  • Accepted : 2024.05.02
  • Published : 2024.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Obesity has known to be a modifiable risk factor associated with worse outcomes in chronic kidney disease (CKD), but few studies have examined the impact of obesity on CKD incidence in the general population. The purpose of this study was to investigate the role of body mass index (BMI) and waist-to-hip ratio (WHR) as predictors of incident CKD and to evaluate the impact of weight reduction on CKD prevention. Methods: A total of 2,711 participants from a community-based cohort with normal renal function were prospectively analyzed. Among participants with obesity, we analyzed the change in WHR to evaluate the association of obesity reduction with CKD development. Results: During a mean follow-up of 11.03 ± 4.22 years, incident CKD occurred in 190 (7.0%) participants. In the fully adjusted multivariable Cox proportional hazard models, the risk of incident CKD increased with higher BMI (hazard ratio, 1.06; 95% confidence interval, 1.00-1.11; p = 0.033) and higher WHR (hazard ratio, 1.33; 95% confidence interval, 1.07-1.66; p = 0.009). In the Kaplan-Meier analysis, cumulative adverse renal events were significantly more common in the maintained obesity group than in the reduced obesity group (p = 0.001). Conclusions: Both higher BMI and WHR were associated with development of CKD, but the magnitude of the effect of WHR was higher than that of BMI. Moreover, reducing obesity would be beneficial for renal prognosis.

Keywords

Acknowledgement

The data used in this study were obtained from the Korean Genome and Epidemiology Study (KoGES; 6635-302), National Institute of Health, Korea Disease Control and Prevention Agency, Republic of Korea. The datasets analyzed in this study are available from the corresponding author on reasonable request. We thank Dr Jinseob Kim and Youngho Kim for providing technical support in data analysis.

References

  1. Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism 2022;133:155217. 
  2. Adler NE, Prather AA. Risk for type 2 diabetes mellitus: person, place, and precision prevention. JAMA Intern Med 2015;175:1321-1322. 
  3. Hall JE. The kidney, hypertension, and obesity. Hypertension. 2003;41(3 Pt 2):625-633. 
  4. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet 2005;366:1059-1062. 
  5. Katta N, Loethen T, Lavie CJ, Alpert MA. Obesity and coronary heart disease: epidemiology, pathology, and coronary artery imaging. Curr Probl Cardiol 2021;46:100655. 
  6. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763-778. 
  7. Foster MC, Hwang SJ, Larson MG, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis 2008;52:39-48. 
  8. Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21-28. 
  9. Mallamaci F, Tripepi G. Obesity and CKD progression: hard facts on fat CKD patients. Nephrol Dial Transplant 2013;28 Suppl 4:iv105-iv108. 
  10. Wickman C, Kramer H. Obesity and kidney disease: potential mechanisms. Semin Nephrol 2013;33:14-22. 
  11. Liyanage T, Toyama T, Hockham C, et al. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health 2022;7:e007525. 
  12. World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization, 2021 [cited 2023 Aug 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 
  13. Kim Y, Han BG; KoGES group. Cohort profile: the Korean Genome and Epidemiology Study (KoGES) consortium. Int J Epidemiol 2017;46:e20. 
  14. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612. 
  15. Haam JH, Kim BT, Kim EM, et al. Diagnosis of obesity: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023;32:121-129. 
  16. Andreacchi AT, Griffith LE, Guindon GE, et al. Body mass index, waist circumference, waist-to-hip ratio, and body fat in relation to health care use in the Canadian Longitudinal Study on Aging. Int J Obes (Lond) 2021;45:666-676. 
  17. Iseki K, Ikemiya Y, Kinjo K, Inoue T, Iseki C, Takishita S. Body mass index and the risk of development of end-stage renal disease in a screened cohort. Kidney Int 2004;65:1870-1876. 
  18. Canoy D, Boekholdt SM, Wareham N, et al. Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study. Circulation 2007;116:2933-2943. 
  19. Elsayed EF, Sarnak MJ, Tighiouart H, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis 2008;52:29-38. 
  20. Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes 2014;7:587-591. 
  21. Horn JW, Feng T, Morkedal B, et al. Obesity and risk for first ischemic stroke depends on metabolic syndrome: the HUNT study. Stroke 2021;52:3555-3561. 
  22. Liang X, Ye M, Tao M, et al. The association between dyslipidemia and the incidence of chronic kidney disease in the general Zhejiang population: a retrospective study. BMC Nephrol 2020;21:252. 
  23. Bosma RJ, van der Heide JJ, Oosterop EJ, de Jong PE, Navis G. Body mass index is associated with altered renal hemodynamics in non-obese healthy subjects. Kidney Int 2004;65:259-265. 
  24. O'Donnell MP, Kasiske BL, Cleary MP, Keane WF. Effects of genetic obesity on renal structure and function in the Zucker rat. II. Micropuncture studies. J Lab Clin Med 1985;106:605-610. 
  25. Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE. Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol 2001;12:1211-1217. 
  26. Ehrhart-Bornstein M, Arakelyan K, Krug AW, Scherbaum WA, Bornstein SR. Fat cells may be the obesity-hypertension link: human adipogenic factors stimulate aldosterone secretion from adrenocortical cells. Endocr Res 2004;30:865-870. 
  27. Hall JE, do Carmo JM, da Silva AA, Wang Z, Hall ME. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat Rev Nephrol 2019;15:367-385. 
  28. Dall'Asta C, Vedani P, Manunta P, et al. Effect of weight loss through laparoscopic gastric banding on blood pressure, plasma renin activity and aldosterone levels in morbid obesity. Nutr Metab Cardiovasc Dis 2009;19:110-114.