Abstract: SA-PO1221
Body Roundness Index and Mortality Risk in Patients with CKD: Moving Beyond the Obesity Paradox
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Yang, Changyuan, Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands
- Vart, Priya, Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands
- Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Gansevoort, Ron T., Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands
- Su, Guobin, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
Background
Body roundness index (BRI), an emerging anthropometric measure, has been shown to outperform body mass index (BMI) in predicting mortality risk in the general population. However, its value among patients with chronic kidney disease (CKD), where the obesity paradox may exist, remains unknown.
Methods
This observational study utilized data from the National Health and Nutrition Examination Survey (NHANES) (2003-2018). BRI was calculated using waist circumference and height, whereas BMI was calculated using body weight and height. Restricted cubic splines (RCS) were applied to determine optimal cutoff points of BRI for all-cause and cardiovascular mortality in patients with CKD. Associations were examined using Cox proportional hazards models adjusted for potential confounders.
Results
Over a median follow-up of 6.6 years, 6,240 patients with CKD (mean age: 63 years, 43% men) were included, with 1,922 all-cause and 715 cardiovascular deaths recorded. RCS demonstrated J-shaped, nonlinear associations between BRI and mortality. A BRI >10 was associated with significantly increased risk of all-cause [adjusted hazard ratio (aHR): 1.82, 95%CI: 1.34-2.47] and cardiovascular mortality (aHR: 2.15, 95%CI: 1.27-3.62) compared to the reference of 5.9-6.8 and 5.9-6.5, respectively. A BMI>30 was paradoxically associated with 44% and 40% lower risks of all-cause and cardiovascular mortality compared to a reference of 18.5-25, respectively. Additional adjustment for body weight (in BRI models) and waist circumference (in BMI models) further strengthened these associations. The associations between BRI >10 and mortality risks were particularly pronounced among younger adults aged <65 years or individuals with elevated albuminuria (p for interaction < 0.05).
Conclusion
Higher BRI, rather than BMI, was independently associated with increased mortality risk among patients with CKD, particularly pronounced among young patients or those with albuminuria. These findings suggest that prioritizing early-life clinical screening and intervention targeting BRI in this population may be an important public health strategy.
Funding
- Government Support – Non-U.S.