Connie M Rhee1, Seyed-Foad Ahmadi, Kamyar Kalantar-Zadeh. 1. Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA.
Abstract
PURPOSE OF REVIEW: Obesity is a major risk factor for the development of de novo chronic kidney disease (CKD). However, once kidney disease is acquired, obesity is paradoxically linked with greater survival, especially in those with advanced CKD. This review examines current evidence for obesity as a risk factor for incident CKD, studies of obesity and mortality across various CKD populations, and potential mechanisms underlying the 'obesity paradox' in kidney disease. RECENT FINDINGS: Large cohort studies show that overweight body habitus, especially in the context of metabolic syndrome, is associated with higher risk of incident CKD. Emerging data also suggest weight-loss interventions retard or reverse early CKD progression, whereas in hemodialysis patients weight-loss paradoxically heralds poor outcomes. Although the pathogenesis of CKD in obesity remains unclear, studies indicate that excess body fat leads to kidney disease via indirect and direct mechanisms. Meta-analyses suggest that overweight and obese BMI ranges are counterintuitively associated with lower mortality in advanced predialysis and dialysis-dependent CKD patients, whereas a pooled analysis observed that higher pretransplantation BMI was associated with higher mortality in kidney transplantation recipients. SUMMARY: In addition to its role as a risk factor for de novo CKD, there appears to be a consistent association between obesity and lower mortality in those with established CKD, particularly among hemodialysis patients, suggesting that the reverse epidemiology of obesity is biologically plausible.
PURPOSE OF REVIEW: Obesity is a major risk factor for the development of de novo chronic kidney disease (CKD). However, once kidney disease is acquired, obesity is paradoxically linked with greater survival, especially in those with advanced CKD. This review examines current evidence for obesity as a risk factor for incident CKD, studies of obesity and mortality across various CKD populations, and potential mechanisms underlying the 'obesity paradox' in kidney disease. RECENT FINDINGS: Large cohort studies show that overweight body habitus, especially in the context of metabolic syndrome, is associated with higher risk of incident CKD. Emerging data also suggest weight-loss interventions retard or reverse early CKD progression, whereas in hemodialysis patientsweight-loss paradoxically heralds poor outcomes. Although the pathogenesis of CKD in obesity remains unclear, studies indicate that excess body fat leads to kidney disease via indirect and direct mechanisms. Meta-analyses suggest that overweight and obese BMI ranges are counterintuitively associated with lower mortality in advanced predialysis and dialysis-dependent CKD patients, whereas a pooled analysis observed that higher pretransplantation BMI was associated with higher mortality in kidney transplantation recipients. SUMMARY: In addition to its role as a risk factor for de novo CKD, there appears to be a consistent association between obesity and lower mortality in those with established CKD, particularly among hemodialysis patients, suggesting that the reverse epidemiology of obesity is biologically plausible.
Authors: M Z Molnar; E Streja; C P Kovesdy; S Bunnapradist; M S Sampaio; J Jing; M Krishnan; A R Nissenson; G M Danovitch; K Kalantar-Zadeh Journal: Am J Transplant Date: 2011-04 Impact factor: 8.086
Authors: Kamyar Kalantar-Zadeh; Joel D Kopple; Ryan D Kilpatrick; Charles J McAllister; Christian S Shinaberger; David W Gjertson; Sander Greenland Journal: Am J Kidney Dis Date: 2005-09 Impact factor: 8.860
Authors: Kamyar Kalantar-Zadeh; Kevin C Abbott; Abdulla K Salahudeen; Ryan D Kilpatrick; Tamara B Horwich Journal: Am J Clin Nutr Date: 2005-03 Impact factor: 7.045
Authors: Kevin C Abbott; Christopher W Glanton; Fernando C Trespalacios; David K Oliver; Maria I Ortiz; Lawrence Y Agodoa; David F Cruess; Paul L Kimmel Journal: Kidney Int Date: 2004-02 Impact factor: 10.612
Authors: A Ari Hakimi; Helena Furberg; Emily C Zabor; Anders Jacobsen; Nikolaus Schultz; Giovanni Ciriello; Nina Mikklineni; Brandon Fiegoli; Philip H Kim; Martin H Voss; Hui Shen; Peter W Laird; Chris Sander; Victor E Reuter; Robert J Motzer; James J Hsieh; Paul Russo Journal: J Natl Cancer Inst Date: 2013-11-27 Impact factor: 13.506
Authors: Petter Bjornstad; Julie A Lovshin; Yuliya Lytvyn; Genevieve Boulet; Leif E Lovblom; Omar N Alhuzaim; Mohammed A Farooqi; Vesta Lai; Josephine Tse; Leslie Cham; Andrej Orszag; Daniel Scarr; Alanna Weisman; Hillary A Keenan; Michael H Brent; Narinder Paul; Vera Bril; Bruce A Perkins; David Z I Cherney Journal: Diabetes Care Date: 2018-02-02 Impact factor: 19.112
Authors: Yoshitsugu Obi; Elani Streja; Rajnish Mehrotra; Matthew B Rivara; Connie M Rhee; Melissa Soohoo; Daniel L Gillen; Wei-Ling Lau; Csaba P Kovesdy; Kamyar Kalantar-Zadeh Journal: Am J Kidney Dis Date: 2017-12-07 Impact factor: 8.860
Authors: Linda L Wong; Kamyar Kalantar-Zadeh; Victoria Page; Glen Hayashida; Amy S You; Connie M Rhee Journal: Am J Nephrol Date: 2017-01-27 Impact factor: 3.754
Authors: Hyunju Kim; Bing Yu; Xin Li; Kari E Wong; Eric Boerwinkle; Sara B Seidelmann; Andrew S Levey; Eugene P Rhee; Josef Coresh; Casey M Rebholz Journal: Am J Clin Nutr Date: 2022-07-06 Impact factor: 8.472