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Obesity, Metabolic Abnormality, and Progression of CKD

 Hae-Ryong Yun  ;  Hyoungnae Kim  ;  Jung Tak Park  ;  Tae Ik Chang  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Suah Sung  ;  Soo Wan Kim  ;  Joongyub Lee  ;  Kook-Hwan Oh  ;  Curie Ahn  ;  Seung Hyeok Han  ;  Seohyun Park  ;  Jong Hyun Jhee  ;  Youn Kyung Kee  ;  Dong Wan Chae  ;  Ho Jun Chin  ;  Hayne Cho Park  ;  Kyubeck Lee  ;  Yong-Soo Kim  ;  Wookyung Chung  ;  Young-Hwan Hwang  ;  Yeong Hoon Kim  ;  Sun Woo Kang 
 AMERICAN JOURNAL OF KIDNEY DISEASES, Vol.72(3) : 400-410, 2018 
Journal Title
Issue Date
CKD progression ; Chronic kidney disease (CKD) ; body mass index (BMI) ; end-stage renal disease (ESRD) ; estimated glomerular filtration rate (eGFR) ; kidney function ; metabolic abnormality ; metabolic syndrome ; obesity ; renal outcome
RATIONALE & OBJECTIVE: Recent studies have yielded conflicting findings on the association between obesity and progression of chronic kidney disease (CKD). Few studies have evaluated whether metabolic abnormalities may accelerate the rate of progression of CKD. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 1,940 participants from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) PREDICTORS: Obesity and metabolic abnormality. Obesity was defined as body mass index ≥ 25kg/m2. Metabolic abnormality was defined as the presence of 3 or more of the following 5 components: hypertension, fasting glucose level > 125mg/dL or the presence of type 2 diabetes, triglyceride level > 150mg/dL or use of lipid-lowering drugs, high-density lipoprotein cholesterol level ≤ 40mg/dL in men and ≤ 50mg/dL in women, and high-sensitivity C-reactive protein level > 1mg/L. OUTCOME: A composite of a 50% decline in estimated glomerular filtration rate from the baseline value or end-stage kidney disease. ANALYTIC APPROACH: Multivariable cause-specific hazards models implemented to assess the association between obesity, metabolic abnormality, and CKD progression. RESULTS: During a mean follow-up of 3.1 years, the primary outcome occurred in 395 (20.4%) patients. In multivariable analyses, after adjustment for confounding factors, obesity and metabolic abnormality were significantly associated with 1.41-fold (95% CI, 1.08-1.83; P=0.01) and 1.38-fold (95% CI, 1.03-1.85; P=0.03) increased risk for adverse renal outcomes, respectively. Patients were categorized into 4 groups depending on the presence of obesity and metabolic abnormality. Compared with those with neither obesity nor metabolic abnormality, those with obesity and metabolic abnormality had a greater risk for CKD progression (HR, 1.53; P=0.03). Those with obesity without metabolic abnormality also had a higher rate of CKD progression (HR, 1.97; P=0.01). LIMITATIONS: Observational study, limited power to detect cardiovascular disease outcomes, unmeasured confounders. CONCLUSIONS: Both metabolic abnormality and obesity are associated with a significantly increased risk for CKD progression. Notably, obese patients without metabolic abnormality also have an elevated risk for CKD progression.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Hyoung Rae(김형래)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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