Abstract
Obesity increases cardio-metabolic risk and has emerged as an important determinant for chronic kidney disease (CKD) in the general population. However, it is uncertain whether weight reduction can prevent the development of CKD. We studied the association between weight loss and development of CKD in healthy individuals using database from a large-scale prospective cohort of the Korean Genome and Epidemiology Study. Among 10,030 participants aged 40-69 years who were recruited between 2001 and 2002, 6,497 healthy subjects without comorbidities were included in the analysis. These subjects were categorized into five group based on quintiles of % changes in body mass index (BMI). The primary outcome of interest was incident CKD, which was defined as an eGFR of < 60 mL/min per 1.73 m2 for two consecutive measurements. During a mean follow-up duration of 9.5 (3.4) years, incident CKD occurred in 455 (7.0%) participants; 4.8, 8.2, 9.0, 8.0, and 6.8 per 1000 patients-years across the quintiles, respectively (P = .01). The lowest quintile group with the largest reduction in BMI was associated with a 42 % decreased risk of incident CKD in multivariable Cox model after adjustment of confounding factors compared to the 3rd quintile group with the smallest change in BMI (hazard ratio [HR], 0.579; 95% CI, 0.408-0.820; P < .001). The beneficial effect of weight loss was consisted in 2nd lowest quintile group (HR, 0.712; 95% CI, 0.215-0.989; P = .04). This association was observed in overweight and obese groups, while the significance was lost in underweight or normal weight group. Interestingly, weight loss in obese participants was associated with a significantly decreased risk of incident CKD compared to those without weight loss and conferred a comparable risk to non-obese counterpart. This favorable effect of weight loss was partly attributed to improvements in blood pressure and metabolic profiles. Changes in BMI positively correlated with changes in blood pressure, insulin resistance, and triglyceride, but negatively correlated with changes in HDL-C and eGFR. Weight loss was associated with decreased risk of developing CKD in healthy individuals without comorbid diseases.
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