Underweight status and development of end-stage kidney disease: A nationwide population-based study

IF 8.9 1区医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-07-28 DOI:10.1002/jcsm.13297

Chang Seong Kim, Tae Ryom Oh, Sang Heon Suh, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Bongseong Kim, Kyung-Do Han, Soo Wan Kim

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Abstract

Background

Underweight status increases the risk of cardiovascular disease and mortality in the general population. However, whether underweight status is associated with an increased risk of developing end-stage kidney disease is unknown.

Methods

A total of 9 845 420 participants aged ≥20 years who underwent health checkups were identified from the Korean National Health Insurance Service database and analysed. Individuals with underweight (body mass index [BMI] < 18.5 kg/m²) and obesity (BMI ≥ 25 kg/m²) were categorized according to the World Health Organization recommendations for Asian populations.

Results

During a mean follow-up period of 9.2 ± 1.1 years, 26 406 participants were diagnosed with end-stage kidney disease. After fully adjusting for other potential predictors, the moderate to severe underweight group (<17 kg/m²) had a significantly higher risk of end-stage kidney disease than that of the reference (normal) weight group (adjusted hazard ratio, 1.563; 95% confidence interval, 1.337–1.828), and competing risk analysis to address the competing risk of death also showed the similar results (adjusted hazard ratio, 1.228; 95% confidence interval, 1.042–1.448). Compared with that of the reference BMI group (24–25 kg/m²), the adjusted hazard ratios for end-stage kidney disease increased as the BMI decreased by 1 kg/m². In the sensitivity analysis, sustained underweight status or progression to underweight status over two repeated health checkups, when compared with normal weight status, had a higher hazard ratio for end-stage kidney disease.

Conclusions

Underweight status is associated with an increased risk of end-stage kidney disease, and this association gradually strengthens as BMI decreases.

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终末期肾病的超重状况和发展：一项全国性的基于人群的研究。

背景：在普通人群中，体重不足会增加患心血管疾病和死亡的风险。然而，体重不足是否与发展为终末期肾病的风险增加有关尚不清楚。方法：从韩国国家健康保险服务数据库中确定并分析了9 845 420名年龄≥20岁接受健康检查的参与者。根据世界卫生组织针对亚洲人群的建议，对体重不足（体重指数[BMI]2）和肥胖（BMI≥25 kg/m2）的个体进行分类。结果：在9.2±1.1年的平均随访期内，26406名参与者被诊断为终末期肾病。在对其他潜在预测因素进行充分调整后，中度至重度体重不足组（2）患终末期肾病的风险显著高于参考（正常）体重组（调整后的危险比为1.563；95%置信区间为1.337-1.828），针对死亡竞争风险的竞争风险分析也显示出类似的结果（调整后的危险比为1.228；95%置信区间为1.042-1.448）。与参考BMI组（24-25 kg/m2）相比，终末期肾病的调整后危险比随着BMI降低1 kg/m2而增加。在敏感性分析中，与正常体重状态相比，持续的体重不足状态或在两次重复健康检查后发展为体重不足状态，对终末期肾病的风险比更高。结论：体重不足与终末期肾病的风险增加有关，并且这种联系随着BMI的降低而逐渐加强。

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来源期刊

Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine

自引率

12.40%

发文量

期刊介绍： The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.