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Abstract: FR-PO273

Association of Body Mass Index and Clinical Outcomes of Advanced CKD in T2DM: A Population-Based Analysis from the National Health Security System

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Rattanasompattikul, Manoch, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
  • Raksasuk, Sukit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Promkan, Moltira, Faculty of Medical Technology, Mahidol University, Salaya, Phutthamonthon, Thailand
  • Masoodi, Sumana, Faculty of Medical Technology, Mahidol University, Salaya, Phutthamonthon, Thailand
  • Ngerninta, Kanyaphak, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
  • Rongkiettechakorn, Nuttawut, Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
  • Supokawej, Aungkura, Faculty of Medical Technology, Mahidol University, Salaya, Phutthamonthon, Thailand
Background

The reversal of the obesity–mortality association has been very robust in patients with end-stage renal disease, but a limited number of studies show conflicting results in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). Several earlier studies found that the association of body mass index (BMI) with CKD is not straightforward in patients with type 2 diabetes mellitus (T2DM). The relationship of obesity with CKD has not been fully explored in Asian populations.

Methods

This study evaluated patients aged >18 years with T2DM obtained from the largest database of the National Health Security System (NHS) of Thailand from 2011to 2014. We aimed to determine the apparent optimum BMI range based on the World Health Organization’s (WHO) criteria concerning the risk of advanced CKD (stages G4 and G5).

Results

With regard to the 27,392 patients, 62% were female, 3% had CKD stage G4 and 1% had CKD stage G5. The mean (±SD) age of the patients was 64±12years old. Mean BMI was 24.9±4.5 kg/m2. The prevalence of having advanced CKD by BMI groups wasBMI (15–20 kg/m2) 6.5%, BMI (20–25 kg/m2) 4.3% (as reference), BMI (25–30 kg/m2) 3.1%, and BMI (>30 kg/m2) 2.6%. The multivariate analysis identified the odds ratio (OR) of BMI (adjusted OR; 95% confidence interval [CI]; P-value) as an independent risk factor for advanced CKD as 1.39; 1.15–1.6; 0.001, 0.8; 0.67–0.94; 0.008, and 0.75; 0.58–0.97; 0.03, respectively (Figure 1).

Conclusion

Patients with advanced CKD in public healthcare practices have strikingly higher rates of low BMI. The negative association of BMI with CKD could reflect reverse causality. This is the first epidemiological paradox that may of concern and be reported in a Southeastern Asian population.

Figure1 The odds ratio (OR) of advanced chronic kidney disease between body mass index groups in Diabetes Mellitus type 2 patients by the three models adjustment.

Funding

  • Government Support - Non-U.S.