Metabolically Healthy Obesity: Epidemiology, Criteria, and Implications in Chronic Kidney Disease

The increasing prevalence of obesity is a worldwide health concern. Although obesity primarily affects the development of cardiometabolic disorders, it has also been closely linked to chronic kidney disease (CKD). However, potential causal relationships between obesity and CKD remain unclear, as obesity and CKD share a number of common risk factors. Accordingly, the risk of incident CKD in obese people without metabolic abnormalities, also called "metabolically healthy obesity" (MHO), has been a matter of interest. Recent investigations found that MHO was related to increased risk of incident CKD; however, the conclusions were based primarily on the static state. According to previous publications, approximately one-half of people initially identified as MHO became metabolically unhealthy, while one-tenth reduced their body weight to normal range while remaining metabolically healthy. It is essential to consider these transitions in obese-metabolic health status when analyzing obesity-related outcomes. This review discusses research on obesity and metabolic health in patients with CKD. Furthermore, we summarize recent reports on the implications of obesity and metabolic health in CKD and discuss the possible mechanisms of their relationship with CKD.