Metabolically Healthy Obesity a misnomer- Overweight don't escape from incident CKD: Study

They categorized 11 body size phenotypes defined by BMI categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and dyslipidemia). The major outcome assessed was incident CKD defined as a recorded code for kidney replacement therapy, a recorded diagnosis of CKD, or by an estimated glomerular filtration rate of <60 mL/min/1.73 m2 for ≥90 days, or a urinary albumin-creatinine ratio >3 mg/mmol for ≥90 days.

Key findings of the study:

• Upon comparing individuals with a metabolically healthy normal weight and healthy overweight/ Obesity, the researchers found a higher risk of incident CKD among those who had metabolically healthy overweight (adjusted HR, 1.30 ) and metabolically healthy obesity (adjusted HR, 1.66).
• They noted that the association was stronger in those younger than 65 years of age.
• In all BMI categories, they observed a greater risk of incident CKD with a greater number of metabolic abnormalities in a graded manner.

The authors concluded, "Overweight and obesity without metabolic abnormality are associated with a higher risk of incident CKD compared with those with normal body weight and no metabolic abnormality".

In an accompanying editorial, Dr Srinivasan Beddhu and his team wrote, "First, we should abandon the term "metabolically healthy obesity." We often see patients in our clinical practice who have reduced eGFR and/or albuminuria and no other risk factors for CKD except obesity. In all cases, we should counsel our patients regarding the hazards of overweight and obesity, as obesity is a risk, or a risk accelerator, for incident CKD. As nephrologists become increasingly focused on reducing cardiometabolic risk as well as the risk of progressive CKD, we should become more facile with dietary, medical, surgical, and other effective weight-loss strategies."

For further information:

DOI: https://doi.org/10.1053/j.ajkd.2021.05.008