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Abstract: PO2420

Effect of Obesity and Metabolic Dysfunction on Cardiovascular Events and Progression to ESRD in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Kim, Jin sug, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kang, Shinyeong, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Dae Kyu, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Jongho, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Yoon, Soo-Young, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Yang gyun, Kyung Hee University Hospital at Gangdong, Seoul, Korea (the Republic of)
  • Lee, Sangho, Kyung Hee University Hospital at Gangdong, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
Background

Obesity and metabolic dysfunction increased the risk of cardiovascular event and chronic kidney disease (CKD) progression. However, there are conflicting results on clinical outcomes in obese patients without metabolic dysfunction and it is unclear whether metabolically healthy obesity increases the risk of cardiovascular events and progression to end-stage renal disease in CKD patients.

Methods

We enrolled 166,397 CKD patients from Korea National Health Insurance Service Health Examinee Cohort between January 2009 and December 2011. Obesity is defined as body mass index greater than 23kg/m2. Metabolic dysfunction was assessed using following components: waist circumference, blood pressure, fasting blood sugar, triglyceride level, high-density lipoprotein cholesterol level. The primary endpoint was the ischemic heart disease, ischemic stroke and progression to end-stage renal disease (ESRD).

Results

Of total CKD patients, the proportion of patients with metabolic dysfunction was significantly higher in obese patients than in non-obese patients (25.1% vs. 5.4%; p < 0.001). In multivariable Cox-regression analysis, compared to metabolically healthy non-obese patients, metabolic dysfunction significantly increased the risk of ischemic heart disease and progression to ESRD in patients with and without obesity. Patients with metabolically healthy obesity were significantly associated with increased risk of ischemic heart disease (HR 1.22; 95% CI 1.00-1.50) and ischemic stroke (HR 1.48; 95% CI 1.10-1.19). However, the risk of progression to ESRD was not significantly increased (HR 0.98; 95% CI 0.87-1.10).

Conclusion

The metabolic dysfunction was significantly associated with worse clinical outcomes in CKD patients, irrespective of obesity. The metabolically healthy obesity increased risk for ischemic heart disease and ischemic stroke, but not for progression to ESRD.