Adolescent obesity major risk factor for early chronic kidney disease in young adulthood: JAMA

The cohort study of 593 660 adolescents revealed that high body mass index (BMI) in late adolescence was associated with early chronic kidney disease (CKD), and there was an increase in risk with increasing severity of obesity. The risk was also seen in seemingly healthy individuals with high-normal BMI and before 30 years of age.

There has been a rise in obesity rates in adolescents, despite this, data regarding early kidney sequelae are lacking. To fill this knowledge gap, Avishai M. Tsur, Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel, and colleagues aimed to assess the association between adolescent BMI and early chronic kidney disease in young adulthood (<45 years of age). Early CKD was defined as stage 1 to 2 CKD by moderately or severely increased albuminuria with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or higher.

The researchers linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. It included adolescents aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service and insured by Maccabi Healthcare Services. Those with dysglycemia, hypertension, albuminuria, kidney pathology, or missing BMI or blood pressure data were excluded.

BMI was calculated as weight (in kilograms) divided by height (in meters squared) and categorized by sex- and age-matched percentiles according to the US Centers for Disease Control and Prevention (CDC). Follow-up initiated at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at the early onset of CKD, death, the last day insured or August 23, 2020 (whichever came first).

The study led to the following findings:

• Of 629 168 adolescents evaluated, 593 660 (mean age at study entry, 17.2 years; 54.5% males) were included in the analysis.
• During a mean follow-up of 13.4 years for males and 13.4 years for females, 0.3% developed early CKD.
• Among males, the adjusted hazard ratios were 1.8 for adolescents with high-normal BMI, 4.0 for those with overweight, 6.7 for those with mild obesity, and 9.4 for those with severe obesity.
• Among females, the hazard ratios were 1.4 for those with high-normal BMI, 2.3 for those with overweight, 2.7 for those with mild obesity, and 4.3 for those with severe obesity.
• The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up.

"These findings underscore the importance of reducing adolescent obesity rates and managing risk factors for kidney disease in adolescents with high body mass index," the researchers concluded.

Reference:

Tsur AM, Akavian I, Landau R, et al. Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood. JAMA Pediatr. Published online December 11, 2023. doi:10.1001/jamapediatrics.2023.5420