Metabolic Syndrome Rather than Obesity Alone Is More Significant for Kidney Disease

Abstract

Introduction: Obesity is associated with metabolic syndrome, nonalcoholic steatohepatitis, and kidney disease. BMI may not be the ideal measure of obesity when used to assess its effect on kidney disease as it does not discriminate for age, sex, ethnicity, muscle, bone, or fat mass.

Objectives: To assess the prevalence microalbuminuria and identify independent risk factors for development of kidney disease in the obese Indian population.

Methods: Age, weight, BMI, total body fat percentage, waist-to-hip ratio, hypertension, urinary albumin-to-creatinine ratio (UACR), and HbA1c were collected from 568 obese patients, presenting for bariatric surgery. Multivariate binary logistic regression was used to identify independent risk factors for kidney disease.

Results: A total of 114 out of 568 (20.07%) obese patients had microalbuminuria (UACR range 30-283 μg/mg). HbA1C levels ≥ 6 (p = 0.01) and hypertension (p = 0.03) were the strongest independent variables for microalbuminuria. 14.67% with a BMI < 35 kg/m², 21.30% with a BMI 35-50 kg/m², and 19.44% with a BMI > 50 kg/m² had microalbuminuria. Increasing BMI however was not statistically significant (p = 0.75). Total body fat percentage (p = 0.51), waist-to-hip ratio (p = 0.96), age (p = 0.30), sex (p = 0.38), and BMI (p = 0.75) were found to be statistically insignificant.

Conclusions: Kidney disease afflicts 1/5th of the obese Indian patients studied. Diabetes and hypertension remained as the most significant risk factors, while age, weight, increasing BMI, waist-to-hip ratio, or increasing body fat were found to be statistically insignificant for development and progression of kidney disease.

Keywords: Age; BMI; Central obesity; Hypertension; Kidney disease; Metabolic syndrome; Microalbuminuria; Obesity; Prevalence; Risk factors; Sex; T2DM; Total body fat percentage; UACR; WHR; Weight.