Vitkauskaitė Monika, Mačionienė Ernesta, Stankevičius Rytis, Miglinas Marius, Ix Joachim H, Brunström Mattias
Vilnius University, Vilnius, Lithuania.
Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Kidney Med. 2025 Feb 13;7(4):100982. doi: 10.1016/j.xkme.2025.100982. eCollection 2025 Apr.
RATIONALE & OBJECTIVE: The association between body mass index (BMI) and chronic kidney disease (CKD) is well established in middle-aged and older adults. Here, we assess the association of BMI in late adolescence with CKD, kidney failure, and acute kidney injury (AKI) later in life.
STUDY DESIGN SETTING & PARTICIPANTS: Population-based cohort study including data from the Swedish Conscription Database, the National Patient Register, the Cause of Death Register, and Statistics Sweden. Conscripts with no history of diabetes, cardiovascular, kidney, or rheumatic diseases enlisted between 1969 and 1997 were followed until December 31, 2019.
MAIN OUTCOMES & EXPOSURES: The study examined the impact of BMI on kidney outcomes. The primary outcome was incident chronic kidney disease. Secondary outcomes were stage 5 chronic kidney disease, end-stage kidney disease, and acute kidney injury.
Patients were stratified into the quintiles of BMI at conscription, and followed until events, death, or censoring, using Cox proportional hazards model, adjusted for baseline systolic and diastolic blood pressure, proteinuria, and socioeconomic factors.
In total, 1,321,481 male participants with a mean age of 18.3 years and a mean BMI of 21.6 kg/m were followed for an average of 35.6 years, generating a total of 47 million person-years of follow-up. During this period, the incidence of CKD-based on diagnosis codes was 5,590, whereas 2,357 subjects were diagnosed with end-stage kidney disease and 8,023 with AKI, respectively. The risk for CKD was increased for the fourth and fifth highest BMI quintile relative to the lowest (adjusted hazard ratio [aHR] 1.23; 95% confidence interval [CI], 1.13-1.35 for BMI 21.9-23.5 kg/m; aHR 2.09; 95% CI, 1.93-2.26 for BMI >23.5 kg/m). Patterns were similar for stage 5 CKD and end-stage kidney disease, whereas the risk for AKI was evident at the third and higher quintiles (aHR 1.14; 95% CI, 1.06-1.23 for BMI 20.7-21.9 kg/m; aHR 1.31; 95% CI, 1.22-1.41 for BMI 21.9-23.5 kg/m; and aHR 1.92; 1.79-2.05 for BMI ≥23.5 kg/m).
A retrospective observational study of male Swedish adolescents.
The findings of this study indicate that, for prevention of kidney disease, the optimal BMI in adolescence with reference to kidney outcomes is likely in the low-normal range.
体重指数（BMI）与慢性肾脏病（CKD）之间的关联在中老年人群中已得到充分证实。在此，我们评估青春期晚期的BMI与CKD、肾衰竭及急性肾损伤（AKI）在生命后期的关联。
研究设计、背景与参与者：基于人群的队列研究，数据来自瑞典征兵数据库、国家患者登记处、死亡原因登记处及瑞典统计局。对1969年至1997年入伍且无糖尿病、心血管疾病、肾脏疾病或风湿性疾病史的应征者进行随访，直至2019年12月31日。
本研究考察BMI对肾脏结局的影响。主要结局为新发慢性肾脏病。次要结局为5期慢性肾脏病、终末期肾病及急性肾损伤。
将患者按征兵时的BMI五分位数分层，并使用Cox比例风险模型随访至发生事件、死亡或失访，模型校正了基线收缩压和舒张压、蛋白尿及社会经济因素。
共纳入1321481名男性参与者，平均年龄18.3岁，平均BMI为21.6kg/m²，平均随访35.6年，总计随访人年数达4700万。在此期间，根据诊断编码得出的CKD发病率为5590例，而分别有2357名受试者被诊断为终末期肾病，8023名受试者被诊断为AKI。相对于BMI最低五分位数，BMI第四和第五高分位数者发生CKD的风险增加（BMI为21.9 - 23.5kg/m²时，校正风险比[aHR]为1.23；95%置信区间[CI]为1.13 - 1.35；BMI>23.5kg/m²时，aHR为2.09；95%CI为1.93 - 2.26）。5期CKD和终末期肾病的模式相似，而AKI的风险在BMI第三及更高五分位数时即明显升高（BMI为20.7 - 21.9kg/m²时，aHR为1.14；95%CI为1.06 - 1.23；BMI为21.9 - 23.5kg/m²时，aHR为1.31；95%CI为1.22 - 1.41；BMI≥23.5kg/m²时，aHR为1.92；95%CI为1.79 - 2.05）。
对瑞典男性青少年的回顾性观察研究。
本研究结果表明，就预防肾脏疾病而言，参考肾脏结局，青春期的最佳BMI可能处于略低于正常范围。
