Obesity as a predictive factor for chronic kidney disease in adults: systematic review and meta-analysis.

K.R.D Pinto,V.N Hirakata,C.M Feckinghaus

doi:10.1590/1414-431x202010022

Abstract

Chronic kidney disease (CKD) is one of the main chronic diseases affecting the world population due to its high prevalence and increasing morbidity. Similarly, obesity gained the interest of the scientific community as it directly or indirectly increases mortality from cardiovascular causes, and its prevalence characterizes a pandemic. The objective of this study was to investigate obesity measured by body mass index as a predictor for end-stage renal disease in the general adult population. A systematic review and meta-analysis was carried out by searching 10 databases for prospective or retrospective cohort studies, with no restrictions on the language of publication, including adults with obesity without previous renal disease and who evolved to CKD (diagnosed by estimated glomerular filtration rate below 60 mL&mac_middot;min-1&mac_middot;(1.73 m2)-1 over the follow-up period. The R software and Meta package were used for data analysis. After removing duplicates, 5431 studies were submitted to the steps of the systematic review, and 21 articles were included in the data analysis. In total, 3,504,303 patients, 521,216 with obesity, and an average follow-up time of 9.86 years were included. The relative risk of obese people for developing CKD in the random effects model was 1.81 (95%CI: 1.52-2.16). The evidence found in this meta-analysis confirmed that obese people are at higher risk of developing CKD that the non-obese population (1.81 times higher), with obesity being a priority risk factor in preventive actions.

Highlights

Chronic kidney disease Chronic kidney disease (CKD) is one of the main chronic diseases that affects the world population
Obesity The most traditional measure for obesity diagnosis is body weight adjusted for height – the body mass index (BMI) – calculated as: weight in kilograms divided by the square of the height in meters [2]
Eligibility Prospective or retrospective observational studies assessing the association between obesity and CKD were included without limitations on the publication date

Summary

Introduction

Chronic kidney disease Chronic kidney disease (CKD) is one of the main chronic diseases that affects the world population. In the United States, according to the National Health and Nutrition Examination Survey, new cases of CKD doubled in individuals over 65 years old from 2000 to 2008 and the prevalence of CKD in the population over 60 years of age went from 18.8% in 2003 to 24.5% in 2006. Based on the 2018 census of the Brazilian Nephrology Society, 133,464 patients were estimated to be under treatment in 781 dialysis units in Brazil, with 80% of dialysis treatments being funded by the Public Health System [1]. According to the World Health Organization, body type is classified based on BMI in 5 categories: o18.5 kg/m2 underweight, 18.5 to 24.9 kg/m2 normal weight, 25 to 29.9 kg/m2 overweight, and 430 kg/m2 obesity [3]. In Asian countries, a different classification is adopted using different cut-offs [4]

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