Background: There is increasing awareness of the impact of obesity on chronic diseases including chronic kidney disease (CKD). Until recently, a limited number of epidemiologic studies have examined the association between obesity and CKD. We conducted a retrospective cohort study to evaluate whether obesity impacts on the rate of non-diabetic CKD progression. Methods: The medical records of 125 non-diabetic CKD patients in the Sheffield Kidney Institute, Sheffield, UK, who have been followed-up for around 10 years, were reviewed. Various socio-demographic, clinical and biochemical parameters were retrospectively collected from the patients’ database. Participants were categorized into normal weight, overweight and obese groups. Multivariate regression analysis was used for modelling with estimated glomerular filtration rate (eGFR) reduction per year as the dependent variable to evaluate the impact of obesity (BMI) on CKD progression. Results: Patients studied were mostly CKD stage 3 with a mean GFR of 36.2 ml/min/1.73 m2 for the control group and 44.3 ml/min/1.73 m2 for those who were overweight or obese. Baseline diastolic and mean arterial blood pressure were significantly higher in overweight than normal weight CKD patients (p = 0.009 and p = 0.014 respectively). On follow-up, systolic, diastolic and mean arterial blood pressure were significantly higher in overweight (p = 0.03, p = 0.005 and p = 0.003, respectively) and obese (p = 0.008, p = 0.022 and p = 0.003, respectively) compared to normal weight CKD patients. Mean follow-up triglycerides level was significantly higher in obese than normal weight patients (p = 0.042). The frequency of CKD progression based on eGFR fall per year (>1 ml/min/1.73 m2/year) was 62.5% in overweight and 79.5% in obese compared to 44.7% in normal weight CKD patients (p = 0.007). However, no significant difference in the rate of progression (fall of eGFR ml/min/1.73 m2/year) was observed between the three groups. On multivariate regression analysis, adjusted for other covariates (age, BP and proteinuria), baseline BMI was an independent predictor of CKD progression (fall in eGFR, ml/min/1.73 m2/year) (R2 = 0.122 and p < 0.001). Percentage changes in BMI over the observation period did not affect the rate of eGFR decline. Young age also predicted a faster CKD progression. Conclusions: Baseline BMI and young age are strongly and independently associated with faster CKD progression based on the annual rate of eGFR fall. Prospective studies to investigate the relationship between BMI and CKD and its complications are warranted.

1.
Beaglehole R, Yach D: Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. Lancet 2003;362:903–908.
2.
Yach D, Hawkes C, Gould CL, Hofman KJ: The global burden of chronic diseases overcoming impediments to prevention and control. JAMA 2004;291:2616–2622.
3.
International Obesity Task Force, 2006 [http://www.iotf.org/].
4.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J: Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217–223.
5.
Atkins RC: The epidemiology of chronic kidney disease. Kidney Int Suppl 2005;98:S14–S18.
6.
King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414–1431.
7.
Tozawa M, Iseki K, Iseki C, Oshiro S, Ikemiya Y, Takishita S: Influence of smoking and obesity on the development of proteinuria. Kidney Int 2002;62:956–962.
8.
Iseki K, Ikemiya Y, Kinjo K, Inoue T, Iseki C, Takishita S: Body mass index and the risk of development of end-stage renal disease in a screened cohort. Kidney Int 2004;65:1870–1876.
9.
Fox CS, Larson MG, Leip EP, Culleton B, Wilson PWF, Levy D: Predictors of new-onset kidney disease in a community-based population. JAMA 2004;291:844–850.
10.
Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS: Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21–28.
11.
Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyren O: Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006;17:1695–1702.
12.
Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD: Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001;59:1498–1509.
13.
Iseki K: The Okinawa Screening Program. J Am Soc Nephrol 2003;14:S127–S130.
14.
Iseki K, Ikemiya Y, Fukiyama K: Predictors of end-stage renal disease and body mass index in a screened cohort. Kidney Int Suppl 1997;63:S169–S170.
15.
Chen J, Muntner P, Hamm LL, et al: The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 2004;140:167–174.
16.
Praga M, Hernandez E, Morales E, et al: Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001;16:1790–1798.
17.
Bonnet F, Deprele C, Sassolas A, et al: Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis 2001;37:720–727.
18.
Meier-Kriesche H, Arndorfer JA, Kaplan B: The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation 2002;73:70–74.
19.
Praga M, Hernandez E, Herrero JC, et al: Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy. Kidney Int 2000;58:2111–2118.
20.
Perry HMJ, Miller JP, Fornoff JR, et al: Early predictors of 15-year end-stage renal disease in hypertensive patients. Hypertension 1995;25:587–594.
21.
Wang Y, Chen X, Song Y, Caballero B, Cheskin L: Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int 2008;73:19–33.
22.
Levey A, Bosch J, Breyer Lewis J, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine. Ann Intern Med 1999;139:461–470.
23.
Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP: Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 1987;16:235–251.
24.
Mulyadi L, Stevens C, Munro S, Lingard J, Bermingham M: Body fat distribution and total body fat as risk factors for microalbuminuria in the obese. Ann Nutr Metab 2001;45:67–71.
25.
Bello AK, de Zeeuw D, El Nahas M, et al: Impact of weight change on albuminuria in the general population. Nephrol Dial Transplant 2007;22:1619–1627.
26.
Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D: Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 2005;46:587–594.
27.
Gelber RP, Kurth T, Kausz AT, et al: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
28.
Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL: Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 2003;14:479–487.
29.
Pinto-Sietsma SJ, Navis G, Janssen WW, de Zeeuw D, Gans RO, de Jong PE: A central body fat distribution is related to renal function impairment, even in lean subjects. Am J Kidney Dis 2003;41:733–741.
30.
Kopple JD, Greene T, Chumlea WC, et al: Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney Int 2000;57:1688–1703.
31.
Mann J, Schmieder R, McQueen M, et al: Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicenter, randomised, double-blind, controlled trial. Lancet 2008;372:547–553.
32.
Lindman R, Tobin J, Shock N: Longitudinal study of rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278–285.
33.
Eriksen B, Ingbresten O: The progression of chronic kidney disease: a 10-year population-based study on the effect of gender and age. Kidney Int 2006;69:375–382.
34.
Evans M, Fryzek JP, Elinder CG, et al: The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden. Am J Kidney Dis 2005;46:863–870.
35.
Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A: Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis 2005;46:233–241.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.