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284 Perspectiva Obesity and kidney disease - C. P. Kovesdy et al Study Patients Exposure Outcomes Results Comments Nation-wide US Veterans Administration cohort14 3,376,187 US veterans with baseline eGFR ≥ 60 mL/min/1.73 m2 Table 1. Continuation BMI categories from < 20 to > 50 kg/m2 Rapid decline in kidney function (negative eGFR slope of > 5 mL/ min/1.73 m2) BMI > 30 kg/m2 associated with rapid loss of kidney function Associations more accentuated in older individuals Nation-wide population-based study from Sweden12 926 Swedes with moderate/advanced CKD compared to 998 controls BMI ≥ 25 vs < 25 kg/m2 CKD vs no CKD Higher BMI associated with 3x higher risk of CKD - Risk strongest in diabetics, but also significantly higher in non-diabetics - Cross sectional analysis Nation-wide population based study in Israel17 1,194,704 adolescent males and females examined for military service Elevated BMI (overweight and obesity) vs normal BMI* Incident ESRD Overweight (HR 3.0) and obesity (HR 6.89) associated with higher risk of ESRD Associations strongest for diabetic ESRD, but also significantly higher for non-diabetic ESRD The Nord-Trøndelag Health Study (HUNT-1)15 74,986 Norwegian adults BMI categories* Incidence of ESRD or renal death BMI > 30 kg/m2 associated with worse outcomes Associations not present in individuals with BL < 120/80 mmHg Community-based screening in Okinawa, Japan16 100,753 individuals > 20 years old BMI quartiles Incidence of ESRD Higher BMI associated with increased risk of ESRD in men, but not in women Average BMI lower in Japan compared to Western countries Nation-wide US Veterans Administration cohort19 453,946 US veterans with baseline eGFR < 60 ml/min per 1.73 m2 BMI categories from < 20 to > 50 kg/m2 - Incidence of ESRD - Doubling of serum creatinine - Slopes of eGFR Moderate and severe obesity associated with worse renal outcomes Associations present but weaker in patients with more advanced CKD Kaiser Permanente Northern California18 320,252 adults with and without baseline CKD Overweight, class I, II and extreme obesity; vs normal BMI* Incidence of ESRD Linearly higher risk of ESRD with higher BMI categories Associations remained present after adjustment for DM, hypertension and baseline CKD REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study21  30,239 individuals Elevated waist circumference or BMI Incidence of ESRD - BMI above normal not associated with ESRD after adjustment for waist circumference - Higher waist circumference associated with ESRD Association of waist circumference with ESRD became on-significant after adjustment for comorbidities and baseline eGFR and proteinuria *Normal weight: BMI 18.5 to 24.9 kg/m2; overweight: BMI 25.0 to 29.9 kg/m2; class I obesity: BMI 30.0 to 34.9 kg/m2; class II obesity: BMI 35.0 to 39.9 kg/m2; class III obesity: BMI ≥40 kg/m2. BMI, body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; ESRD, end stage renal disease; HR, hazard ratio; OR, odds ratio; UACR, urine albumin-creatinine ratio. Rev Med Chile 2017; 145: 281-291


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