Metabolically Healthy Obesity and Risk of Kidney Function Decline.

Abstract

ObjectiveTo examine the association between body mass index (BMI) categories, stratified by metabolic health status, and risk of kidney function declineMethodsWe classified 42,128 adult patients with stable BMI over a 3-year baseline window by BMI and metabolic health status (assessed by Adult Treatment Panel-III criteria). Kidney function decline (KFD) was defined as eGFR decline ≥ 30%, eGFR<15 ml/min/1.73m2, or receipt of dialysis/transplant.ResultsOver a median of 5.1 years (IQR 2.1–8.9), 6,533 (15.5%) individuals developed KFD. Compared to the normal weight, metabolically healthy category, metabolically healthy obesity (MHO) was associated with higher risk of KFD [adjusted hazard ratio (aHR) 1.52, 95% CI: 1.22– 1.89]. Adjusted HRs for KFD were 1.17 (95% CI: 0.89 –1.53), 2.21 (95% CI: 1.59 – 3.08), and 2.20 (95% CI: 1.55–3.11) for MHO with BMI 30–34.9, BMI 35–39.9, and BMI ≥ 40 kg/m2. These associations were consistent among men and women, patients with eGFR ≥ or < 90 ml/min/1.73m2, and age ≥ or < 55 y. Risk of KFD was highest among metabolically unhealthy individuals with BMI ≥ 40 (aHR 4.02, 95% CI: 3.40–4.75 vs. metabolically healthy, normal weight individuals).ConclusionsObesity, whether in the presence or absence of metabolic health, is a risk factor for KFD.