Kim Yoon Ji, Hwang Seun Deuk, Oh Tae Jung, Kim Kyoung Min, Jang Hak Chul, Kimm Heejin, Kim Hyeon Chang, Jee Sun Ha, Lim Soo
1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Mediplex Sejong Hospital , Incheon, South Korea .
2 Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine , Incheon, South Korea .
Metab Syndr Relat Disord. 2017 Oct;15(8):416-422. doi: 10.1089/met.2017.0053. Epub 2017 Aug 23.
Chronic kidney disease (CKD) has often been defined based on glomerular filtration rate (GFR) alone. The Kidney Disease: Improving Global Outcomes guideline highlights albuminuria in the CKD definition. Thus, we investigated the association between obesity and CKD, as defined by both GFR and albuminuria, in Korean adults.
We used Korea National Health and Nutrition Examination Survey 2011-2014 data (N = 19,331, ≥19 years old) representing the national Korean population. CKD was classified by (1) estimated GFR (eGFR) < 60 mL/min/1.73 m (CKD); (2) albumin-to-creatinine ratio (ACR) ≥30 mg/gram (CKD); and (3) eGFR < 60 mL/min/1.73 m or ACR ≥30 mg/gram (CKD). Associations between obesity and each CKD category were evaluated using multivariate logistic regression analysis.
The prevalence rates of CKD, CKD, and CKD were 2.2%, 6.7%, and 8.1%, respectively. Compared with the normal body mass index (BMI; 18.5-22.9 kg/m) group, men with BMI ≥ 25 kg/m had 1.88 times greater risk of CKD in the adjusted model [95% confidence interval (CI), 1.26-2.80; P = 0.002]; BMI was not significantly associated with CKD in women. In contrast, both men and women with BMI ≥ 25 kg/m had 1.58 and 1.40 times higher risk of CKD (95% CI, 1.21-2.07 and 1.08-1.81, respectively, both P < 0.01). Obese men and women had 1.65 and 1.38 times higher risk of CKD (95% CI, 1.29-2.12 and 1.09-1.75, respectively, both P < 0.01).
Obesity was significantly associated with an increased ACR-based CKD risk. Longitudinal studies are needed to investigate the role of overweight and obesity in the development and progression of CKD.
慢性肾脏病（CKD）以往常仅基于肾小球滤过率（GFR）来定义。《改善全球肾脏病预后组织》指南强调了CKD定义中的蛋白尿。因此，我们在韩国成年人中研究了肥胖与由GFR和蛋白尿所定义的CKD之间的关联。
我们使用了2011 - 2014年韩国国家健康与营养检查调查数据（N = 19331，年龄≥19岁），该数据代表了韩国全国人口。CKD的分类如下：（1）估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²（CKD）；（2）尿白蛋白与肌酐比值（ACR）≥30 mg/克（CKD）；以及（3）eGFR<60 mL/min/1.73 m²或ACR≥30 mg/克（CKD）。使用多因素逻辑回归分析评估肥胖与每种CKD类别之间的关联。
CKD、CKD和CKD的患病率分别为2.2%、6.7%和8.1%。与正常体重指数（BMI；18.5 - 22.9 kg/m²）组相比，在调整模型中，BMI≥25 kg/m²的男性患CKD的风险高1.88倍[95%置信区间（CI），1.26 - 2.80；P = 0.002]；BMI与女性的CKD无显著关联。相比之下，BMI≥25 kg/m²的男性和女性患CKD的风险分别高1.58倍和1.40倍（95% CI分别为1.21 - 2.07和1.08 - 1.81，P均<0.01）。肥胖男性和女性患CKD的风险分别高1.65倍和1.38倍（95% CI分别为1.29 - 2.12和1.09 - 1.75，P均<0.01）。
肥胖与基于ACR的CKD风险增加显著相关。需要进行纵向研究以调查超重和肥胖在CKD发生和发展中的作用。
