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Abstract: SA-OR40

Obesity Weight Loss Phenotypes in CKD: Data From the Chronic Renal Insufficiency Cohort Study (CRIC)

Session Information

Category: Health Maintenance‚ Nutrition‚ and Metabolism

  • 1400 Health Maintenance‚ Nutrition‚ and Metabolism

Authors

  • Harhay, Meera Nair, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
  • Robinson, Lucy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
  • Kim, Yuna, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
  • Milliron, Brandy-Joe, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, United States
Background

Although adults with chronic kidney disease (CKD) and obesity are often advised to lose weight, weight loss may also signal a decrease in physiologic reserve and higher mortality risk. The aim of this study was to identify features of high-risk weight loss among individuals with obesity and CKD.

Methods

We identified CRIC participants with a BMI of ≥30 kg/m2 at baseline. We estimated a multivariate latent class model to identify distinct trajectories of change from baseline BMI, mean arterial pressure (MAP), and % fat free mass (FFM) using nonlinear trends over time for each variable and subject-level random effects. We fit a Cox model for death using estimated latent classes and adjusted for race/ethnicity, sex, and baseline age, BMI, %FFM, MAP, diabetes, and estimated glomerular filtration rate (eGFR).

Results

Among 2,909 CRIC participants (median baseline BMI 35.5 (IQR 32.4-39.9) kg/m2), median follow-up time was 6.4 years, median age was 61 (interquartile range [IQR] 54-67) years, 53% were male, 37% were non-Hispanic White, and 82% were trying to lose weight. Median BMI was 35.5 (IQR 32.4-39.9) kg/m2. We observed six distinct latent classes in the study cohort, defined by similar patterns of changes over time in BMI, MAP, and %FFM (Figure). Latent classes were independently and significantly associated with mortality risk (p=0.009); class 6 had the lowest unadjusted mortality. Relative to class 6, those in class 1 were younger (58 vs 62 years) more likely to be female (65% vs 46%), have diabetes (70% vs 57%), have higher initial BMI (42 vs 35 kg/m2) and MAP (88 vs 85 mm Hg), and lower eGFR (36.9 vs 47.3 ml/min/1.73m2) and %FFM (56 vs 62%) at baseline. After multivariable adjustment, class 1 was associated with a nearly 2-fold higher death risk relative to class 6 (adjusted Hazard Ratio 1.9, 95% Confidence Interval 1.18-2.41, p=0.004).

Conclusion

Among individuals with CKD and obesity, the pattern characterized by steep initial BMI loss, increase in %FFM, and stable MAP was associated with the highest risk of death.

Funding

  • NIDDK Support