#6963 OBESITY, METABOLIC SYNDROME AND THE RISK OF ADVERSE CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

Abstract Background and Aims Obesity and metabolic syndrome are prevalent disorder in patients with chronic kidney disease (CKD). However, it is unclear whether obesity without metabolic syndrome is associated with higher risk of adverse clinical outcomes in patients with CKD. Method We reviewed the National Health Insurance Service database of Korea for people who received ≥2 national health screenings between 2009 and 2011. A total of 68,464 chronic kidney disease patients were identified with consecutive estimated glomerular filtration rate <60 ml/min per 1.73 m2. Obesity was defined as body mass index ≥25 kg/m2 and metabolic syndrome status was considered as the presence of three or more of the following metabolic factors; waist circumference, blood pressure, fasting blood sugar, triglyceride level, high-density lipoprotein cholesterol level. The primary outcomes were cardiovascular events, end-stage renal disease progression (ESRD) and all-cause mortality. Results Compared to non-obese patients without metabolic syndrome, obesity without metabolic syndrome did not increase the risk of cardiovascular event (HR 1.02, 95% CI 0.95–1.11) and progression to ESRD (HR 0.86, 95% CI 0.73–1.02). Risk of all-cause mortality was significantly decreased in these patients (HR 0.88, 95% CI 0.81–0.96). These findings were consistently observed in overweight, obese, morbid obese patients without metabolic syndrome. In addition, while linear increase of HRs for each additional metabolic abnormality was observed, HRs increase for cardiovascular event was significantly slower in obese patients than in non-obese (P for interaction = 0.035). Conclusion Obesity without metabolic syndrome did not confer excess risk for cardiovascular complication or ESRD progression and decreased the risk of all-cause mortality. Healthy effect of obesity against mortality risk and metabolic hazard on cardiovascular event is better to be considered in CKD patients.