Obesity, metabolic health, and the risk of end-stage renal disease

Obesity is associated with chronic kidney disease progression. Whether metabolic risk factors modify this association is unclear. Here we examined associations of body mass index (BMI) and metabolic health with risk of end-stage renal disease (ESRD) in the Reason for Geographic and Racial Differences in Stroke (REGARDS) study. Among 21,840 participants eligible for analysis, 247 developed ESRD (mean follow-up of 6.3 years). Metabolic health significantly modified the association of BMI with ESRD. In models stratified by presence or absence of metabolic syndrome and adjusted for demographic, lifestyle and clinical factors, higher BMI was associated with lower risk of ESRD in those without (hazard ratio per 5 kg/m(2) increase in BMI 0.70, 95%CI 0.52,0.95), but not those with (hazard ratio, 1.06) metabolic syndrome. In models stratified by weight and metabolic health, compared to normal weight (BMI 18.5–24.9 kg/m2) participants without metabolic syndrome the overweight individuals (BMI 25–29.9) and obese individuals (BMI of 30 or more) with metabolic syndrome had greater risk of ESRD (hazard ratios of 2.03 and 2.29, respectively), whereas obesity without the metabolic syndrome was associated with lower risk of ESRD (hazard ratio 0.47). Thus, higher BMI is associated with lower ESRD risk in those without but not those with metabolic syndrome.