P0784RAPID WEIGHT CHANGE OVER TIME IS A RISK FACTOR FOR ADVERSE OUTCOMES IN PREDIALYSIS CHRONIC KIDNEY DISEASE: RESULTS FORM KNOW-CKD STUDY

Abstract

Abstract Background and Aims Both obesity and underweight are related to the adverse outcomes in the chronic kidney disease (CKD). However, the effects of longitudinal weight changes on predialysis CKD population has not been studies so far. In this study, we analysed the effects of longitudinal body weight changes on the adverse outcomes in the predialysis CKD population, using the multicentre prospective cohort study in Korean pre-dialysis CKD cohort, so called KNOW-CKD. Method In this longitudinal analysis, total 2,022 patients were included. Longitudinal weight changes of study population were calculated into the percent change per year using regression analysis and classified into five groups: group 1; ≤ -5%/year (74 subjects), group 2; -5< to ≤-2.5 %/year (122 subjects), group 3; -2.5< to <2.5%/year (1642 subjects), group 4; 2.5≤ <5 %/year (123 subjects), and group 5; ≥ 5 %/year (61 subjects). The risk of end-stage renal disease (ESRD) development and composite outcome of cardiovascular disease (CVD) and all-cause death were compared according to the longitudinal weight changes. Results During the median 4.4 years of follow-up, total 414 and 188 events of ESRD and composite outcome of CVD and death occurred. When cause-specific regression analysis was conducted before and after adjusting age, sex, body mass index, mean blood pressure, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, diabetics, cardiovascular disease, and modified Charlson Comorbidity Index score, all groups showed significant increased HR compared to group 3 for the ESRD. There was U-shape correlation between the degree of longitudinal body weight changes and the renal outcome (HR 3.89, 2.00, 1.89 and 3.34, P <0.001, <0.001, =0.001 and <0.001 for group 1, 2, 4 and 5, respectively). Also similar U-shape relationship was seen with composite outcome, (HR 3.14, 2.05, 1.65 and 2.68, P <0.001, 0.007, 0.123 and 0.007 for group 1, 2, 4 and 5, respectively) when compared to the reference group 3 When spline curve was drawn between the longitudinal body weight changes and adjusted HR for ESRD and composite of CVD and death, clear U-shape relationship was observed (Figure). The U-shape correlation was highlighted in the subgroup of estimated glomerular filtration rate <45 mL/min/1.73m2. Conclusion Both rapid weight reduction and gain are independent risk factor for the ESRD development and composite outcome of CVD and death in predialysis CKD patients, especially in advanced CKD stages. Therefore, monitoring bodyweight changes are important and more studies are needed to give safe guideline to the predialysis CKD for maintaining optimal nutritional status.