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. 2022 May 15;11(10):2787.
doi: 10.3390/jcm11102787.

Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes

Chi-Chih Hung  1   2 , Pei-Hua Yu  1   3 , Sheng-Wen Niu  4 , I-Ching Kuo  4 , Jia-Jung Lee  1   2 , Feng-Ching Shen  1 , Jer-Ming Chang  1   5 , Shang-Jyh Hwang  1   5
Affiliations

Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes

Chi-Chih Hung et al. J Clin Med. .

Abstract

Obesity-related nephropathy is associated with renal function progression. However, some studies have associated a high body mass index (BMI) with improved renal outcomes—this is referred to as the obesity paradox for renal outcomes, especially in relation to advanced chronic kidney disease (CKD). Central obesity can explain the obesity paradox in all-cause mortality. However, whether obesity or central obesity is associated with renal outcomes (renal replacement therapy or a 50% decline in the estimated glomerular filtration rate) in patients with advanced CKD remains unclear. Our study included 3605 Asian patients with CKD stages 1−5 divided into six groups according to their BMI (between 15 and 35 kg/m2). Through linear regression, BMI was positively associated with hemoglobin and albumin at CKD stages 4 and 5. In the competing risk Cox regression model, a high BMI (27.5−35 kg/m2) was associated with renal outcomes at CKD stages 1−3, but not stages 4 and 5. A high BMI was associated with renal outcomes in patients with hemoglobin ≥11 g/dL, but not <11 g/dL. A high waist-to-hip ratio was not associated with renal outcomes. We conclude that the CKD stage and anemia may explain the obesity paradox in renal outcomes in patients with CKD.

Keywords: anemia; body mass index; central obesity; chronic kidney disease; obesity paradox; renal outcome; waist-to-hip ratio.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Association between BMI and renal outcomes according to CKD stage. (a) Hazard ratios for renal outcomes according to BMI before and after adjustment in patients with CKD stages 1–5. (b) Hazard ratios for renal outcomes according to BMI before and after adjustment in patients with CKD stages 1–4. (c) Hazard ratios for renal outcomes according to BMI before and after adjustment in patients with CKD stages 1–3. Renal outcomes are defined as renal replacement therapy and a 50% decline in eGFR. Abbreviations: BMI, body mass index; CKD, chronic kidney disease.
Figure 2
Figure 2
Association between BMI and renal outcomes according to Hb levels. (a) Hazard ratios for renal outcomes according to BMI before and after adjustment in all patients. (b) Hazard ratios for renal outcomes according to BMI before and after adjustment for patients with Hb ≥ 9. (c) Hazard ratios for renal outcomes according to BMI before and after adjustment for patients with Hb ≥ 11. Renal outcomes are defined as renal replacement therapy and a 50% decline in eGFR. Abbreviations: BMI, body mass index; Hb, hemoglobin.
Figure 3
Figure 3
Diagnostic flowchart for renal outcome in CKD patients. Abbreviations: CKD, chronic kidney disease; BMI, body mass index; Hb, hemoglobin.
See this image and copyright information in PMC

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