Department of Nephrology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
Department of Nephrology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; Spanish Kidney Research Network (REDinREN), Madrid, Spain.
Hipertens Riesgo Vasc. 2021 Apr-Jun;38(2):63-71. doi: 10.1016/j.hipert.2020.09.004. Epub 2020 Oct 21.
Obesity is a major health problem worldwide. It carries a markedly increased risk for multiple diseases such as type 2 diabetes mellitus, hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD). To complicate an already difficult topic a new subtype of obesity has been defined lately, the metabolically healthy obese. Our study aimed to clarify the association between obesity, metabolic syndrome and kidney disease progression.
Observational retrospective single centre study including 212 patients with stage 3-4 CKD with no previous history of rapid kidney disease progression. Patients were divided according to BMI status and presence of metabolic syndrome. Anthropometric, clinical and laboratory data were collected to follow-up. Propensity score matching was performed for age, albuminuria and baseline renal function. During follow-up renal and cardiovascular events were recorded.
After a mean follow-up of 88.44±36.07 months a total of 18 patients reached the renal outcome in the non-obese group and 21 in the obese group. Differences were not statistically significant (log rank=0.21: p=0.64). Multiple Cox regression analysis showed that obesity was not predictor for worse renal outcomes [HR 1.01, 95% CI 0.45-2.24; p=0.97]. When stratifying the sample according to baseline metabolic syndrome and obesity presence there was no difference in renal survival (log rank=0.852; p=0.35) A total of 48 cardiovascular events were registered: seventeen in the non-obese group and thirty-one in the obese group. Differences in event-free time between both groups were statistically significant (log rank=4.44;p=0.035), especially after four years of follow-up. After stratifying for MS and obesity presence at baseline the event-free time differences where again statistically significant (log rank=16.86;p=0.001), specially for the obese patients with metabolic syndrome.
Obesity has little impact on chronic kidney disease progression despite the presence or absence of metabolic syndrome in a cohort matched for age, baseline renal function and albuminuria. Obesity conferred greater cardiovascular risk when combined with metabolic syndrome.
肥胖是全球范围内的一个主要健康问题。它会显著增加多种疾病的风险，如 2 型糖尿病、高血压、心血管疾病 (CVD) 和慢性肾脏病 (CKD)。为了使本来就复杂的问题更加复杂，最近定义了一种新的肥胖亚型，即代谢健康型肥胖。我们的研究旨在阐明肥胖、代谢综合征与肾脏疾病进展之间的关系。
本研究为观察性回顾性单中心研究，纳入 212 例无快速肾脏病进展史的 3-4 期 CKD 患者。根据 BMI 状况和代谢综合征的存在将患者进行分组。收集人体测量学、临床和实验室数据进行随访。为年龄、蛋白尿和基线肾功能进行了倾向评分匹配。随访期间记录肾脏和心血管事件。
在平均 88.44±36.07 个月的随访后，非肥胖组共有 18 例患者达到肾脏终点，肥胖组有 21 例。差异无统计学意义（对数秩检验=0.21：p=0.64）。多因素 Cox 回归分析显示，肥胖并不是肾脏预后不良的预测因素[HR 1.01，95%CI 0.45-2.24；p=0.97]。当根据基线代谢综合征和肥胖的存在对样本进行分层时，肾脏存活率无差异（对数秩检验=0.852；p=0.35）。共登记了 48 例心血管事件：非肥胖组 17 例，肥胖组 31 例。两组之间无事件生存时间差异具有统计学意义（对数秩检验=4.44；p=0.035），特别是在随访四年后。在分层基线时的 MS 和肥胖存在后，无事件生存时间差异再次具有统计学意义（对数秩检验=16.86；p=0.001），特别是对于患有代谢综合征的肥胖患者。
在匹配年龄、基线肾功能和蛋白尿的队列中，肥胖即使存在或不存在代谢综合征，对慢性肾脏病进展的影响也很小。肥胖合并代谢综合征会增加心血管风险。
