Metabolic subtypes and risk of mortality in normal weight, overweight, and obese individuals with CKD Journal Article

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Authors: Hanks, L. J.; Tanner, R. M.; Muntner, P; Kramer, H; McClellan, W. M.; Warnock, D. G.; Judd, S. E.; Gutierrez, O. M.; REGARDS Investigators
Article Title: Metabolic subtypes and risk of mortality in normal weight, overweight, and obese individuals with CKD
Abstract: BACKGROUND AND OBJECTIVES: Higher body mass index (BMI) is paradoxically associated with lower mortality in persons with CKD, but whether cardiometabolic abnormalities modulate this association is unclear. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: Participants with CKD from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=4374) were analyzed. The harmonized criteria for metabolic syndrome were used to define metabolic health, and participants were categorized into one of six mutually exclusive categories defined by combined measures of metabolic health (metabolically healthy, /=3 criteria) and weight status (normal weight, BMI 18.5-24.9 kg/m(2); overweight, BMI 25-29.9 kg/m(2); obese, BMI >/=30 kg/m(2)). Cox models were used to estimate the hazard ratio (HR) of death as a function of each category. RESULTS: A total of 683 deaths were observed over a mean 4.5 years of follow-up. In analyses adjusted for age, race, sex, and geographic region of residence, compared with metabolically healthy normal weight persons, the HRs of mortality in metabolically healthy overweight and obese persons were 0.68 (95% confidence interval [95% CI], 0.53 to 0.87) and 0.71 (95% CI, 0.51 to 0.98), respectively, whereas there were no statistically significant differences in survival among metabolically unhealthy overweight or obese individuals. After further adjustment for lifestyle, clinical and laboratory factors including markers of kidney function, the HR of mortality remained lower in metabolically healthy overweight individuals compared with metabolically healthy normal weight individuals (HR, 0.74; 95% CI, 0.57 to 0.96). CONCLUSIONS: Metabolic abnormalities may attenuate the magnitude and strength of survival benefits associated with higher BMI in individuals with CKD.
Journal Title: Clinical journal of the American Society of Nephrology : CJASN
Volume: 8
Issue: 12
ISSN: 1555-905X; 1555-9041
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 2064
End Page: 2071
Language: eng
DOI/URL:

10.2215/CJN.00140113
Notes: LR: 20150116; GR: K23DK081673/DK/NIDDK NIH HHS/United States; GR: R03DK095005/DK/NIDDK NIH HHS/United States; GR: T32 DK007545/DK/NIDDK NIH HHS/United States; GR: T32DK007545/DK/NIDDK NIH HHS/United States; GR: U01 NS041588/NS/NINDS NIH HHS/United States; JID: 101271570; 0 (Biological Markers); OID: NLM: PMC3848389; 2013/10/31 [aheadofprint]; ppublish