Metabolic subtypes and risk of mortality in normal weight, overweight, and obese individuals with CKD

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Lynae J Hanks1, Rikki M Tanner, Paul Muntner

  • 1Departments of Medicine, , †Nutrition Sciences, , ‡Epidemiology, and , ¶Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; , §Department of Preventive Medicine, Loyola University, Maywood, Illinois, ‖Departments of Epidemiology and Medicine, Emory University, Atlanta, Georgia.

Clinical Journal of the American Society of Nephrology : CJASN
|November 2, 2013
PubMed

Insights

Higher body mass index (BMI) is linked to lower mortality in chronic kidney disease (CKD) patients. However, metabolic abnormalities may reduce this survival benefit, especially in metabolically unhealthy individuals.

Area of Science:

  • Nephrology
  • Cardiology
  • Metabolic Health

Background:

  • Higher body mass index (BMI) is paradoxically associated with lower mortality in individuals with chronic kidney disease (CKD).
  • The role of cardiometabolic abnormalities in modulating this association remains unclear.

Purpose of the Study:

  • To investigate whether cardiometabolic abnormalities influence the association between BMI and mortality in CKD patients.
  • To examine the interplay between metabolic health, weight status, and mortality risk in individuals with CKD.

Main Methods:

  • Analysis of 4374 CKD participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
  • Categorization based on harmonized criteria for metabolic syndrome (metabolically healthy vs. unhealthy) and weight status (normal weight, overweight, obese).
  • Use of Cox models to estimate hazard ratios (HR) for mortality.

Main Results:

  • In metabolically healthy individuals, overweight (HR 0.68) and obese (HR 0.71) participants had lower mortality compared to normal weight individuals.
  • No significant survival differences were observed among metabolically unhealthy overweight or obese individuals.
  • The survival benefit of being overweight in metabolically healthy individuals persisted after adjusting for lifestyle, clinical, and kidney function markers (HR 0.74).

Conclusions:

  • Metabolic abnormalities may attenuate the survival benefits associated with higher BMI in individuals with CKD.
  • Maintaining metabolic health is crucial for realizing the potential survival advantages of higher BMI in CKD patients.
Abstract

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