Obesity and kidney disease: hidden consequences of the epidemic

Kovesdy, Csaba P.; Furth, Susan L.; Zoccali, Carmine

doi:10.5935/0101-2800.20170001

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Editorial • J. Bras. Nefrol. 39 (1) • Jan-Mar 2017 • https://doi.org/10.5935/0101-2800.20170001 linkcopy

Obesity and kidney disease: hidden consequences of the epidemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

Keywords:
chronic kidney disease; kidney cancer; nephrolithiasis; obesity; prevention

Study	Patients	Exposure	Outcomes	Results	Comments
Prevention of Renal and Vascular End- Stage Disease (PREVEND) Study ⁸	7,676 Dutch individuals without diabetes	Elevated BMI (overweight and obese *), and central fat distribution (waist-hip ratio)	-Presence of urine albumin 30-300 mg/24h -Elevated and diminished GFR	-Obese + central fat: higher risk of albuminuria -Obese +/- central fat: higher risk of elevated GFR -Central fat +/- obesity associated with diminished filtration	Cross sectional analysis
Multinational study of hypertensive outpatients ²⁰	20,828 patients from 26 countries	BMI and waist circumference	Prevalence of albuminuria by dip stick	Higher waist circumference associated with albuminuria independent of BMI	Cross sectional analysis
Framingham Multi-Detector Computed Tomography (MDCT) cohort ²²	3,099 individuals	Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT)	Prevalence of UACR > 25 mg/g in women and > 17 mg/g in men	VAT associated with albuminuria in men, but not in women	Cross sectional analysis
CARDIA (Coronary Artery Risk Development in Young Adults) study ¹¹	2,354 community-dwelling individuals with normal kidney function aged 28-40 years	-Obesity (BMI > 30 kg/m²) -Diet and lifestyle-related factors	Incident microalbuminuria	Obesity (OR 1.9) and unhealthy diet (OR 2.0) associated with incident albuminuria	Low number of events
Hypertension Detection and Follow-Up Program ¹⁰	5,897 hypertensive adults	Overweight and obese BMI*vs. normal BMI	Incident CKD (1+ or greater proteinuria on urinalysis and/or an eGFR < 60 mL/ min/1.73 m²)	Both overweight (OR 1.21) and obesity (OR 1.40) associated with incident CKD	Results unchanged after excluding diabetics
Framingham Offspring Study ⁹	2,676 individuals free of CKD stage 3	High vs. normal BMI*	-Incident CKD stage 3 -Incident proteinuria	-Higher BMI not associated with CKD3 after adjustments -Higher BMI associated with increased odds of incident proteinuria	Predominantly white, limited geography
Physicians' Health Study¹³	11,104 initially healthy men in US	-BMI quintiles -Increase in BMI over time (vs. stable BMI)	Incident eGFR < 60 mL/min/1.73 m²	-Higher baseline BMI and increase in BMI over time both associated with higher risk of incident CKD	Exclusively men
Nation-wide US Veterans Administration cohort ¹⁴	3,376,187 US veterans with baseline eGFR ≥ 60 mL/min/1.73 m²	BMI categories from < 20 to > 50 kg/m²	Rapid decline in kidney function (negative eGFR slope of > 5 mL/ min/1.73 m²)	BMI > 30 kg/m² associated with rapid loss of kidney function	Associations more accentuated in older individuals
Nation-wide population-based study from Sweden ¹²	926 Swedes with moderate/advanced CKD compared to 998 controls	BMI ≥ 25 vs. < 25 kg/m²	CKD vs. no CKD	Higher BMI associated with 3x higher risk of CKD	-Risk strongest in diabetics, but also significantly higher in non-diabetics -Cross sectional analysis
Nation-wide population based study in Israel ¹⁷	1,194,704 adolescent males and females examined for military service	Elevated BMI (overweight and obesity) vs. normal BMI*	Incident ESRD	Overweight (HR 3.0) and obesity (HR 6.89) associated with higher risk of ESRD	Associations strongest for diabetic ESRD, but also significantly higher for non-diabetic ESRD
The Nord- Trøndelag Health Study (HUNT-1) ¹⁵	74,986 Norwegian adults	BMI categories*	Incidence of ESRD or renal death	BMI > 30 kg/m² associated with worse outcomes	Associations not present in individuals with BL < 120/80 mmHg
Community-based screening in Okinawa, Japan ¹⁶	100,753 individuals > 20 years old	BMI quartiles	Incidence of ESRD	Higher BMI associated with increased risk of ESRD in men, but not in women	Average BMI lower in Japan compared to Western countries
Nation-wide US Veterans Administration cohort ¹⁹	453,946 US veterans with baseline eGFR < 60 ml/min per 1.73 m²	BMI categories from < 20 to > 50 kg/m²	-Incidence of ESRD -Doubling of serum creatinine -Slopes of eGFR	Moderate and severe obesity associated with worse renal outcomes	Associations present but weaker in patients with more advanced CKD
Kaiser Permanente Northern California ¹⁸	320,252 adults with and without baseline CKD	Overweight, class I, II and extreme obesity; vs. normal BMI*	Incidence of ESRD	Linearly higher risk of ESRD with higher BMI categories	Associations remained present after adjustment for DM, hypertension and baseline CKD
REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study ²¹	30,239 individuals	Elevated waist circumference or BMI	Incidence of ESRD	BMI above normal not associated with ESRD after adjustment for waist circumference -Higher waist circumference associated with ESRD	Association of waist circumference with ESRD became on-significant after adjustment for comorbidities and baseline eGFR and proteinuria

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Normal weight: BMI 18.5 to 24.9 kg/m²; overweight: BMI 25.0 to 29.9 kg/m²; class I obesity: BMI 30.0 to 34.9 kg/m²; class II obesity: BMI 35.0 to 39.9 kg/m²; class III obesity: BMI ≥ 40 kg/m2; BMI: body mass index; CKD: chronic kidney disease; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; ESRD: end stage renal disease; HR: hazard ratio; OR: odds ratio; UACR: urine albumin-creatinine ratio.