medwireNews: Adolescents with obesity are at increased risk for early chronic kidney disease (CKD) in young adulthood, particularly those with severe obesity, indicate findings from a study published in JAMA Pediatrics.
The increased risk for CKD was evident even in adolescents who had a high-normal BMI and were otherwise healthy, with CKD onset sometimes occurring before the age of 30 years. It was also more pronounced in men than women, note the researchers.
“These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI,” say Gilad Twig (Sheba Medical Center, Ramat Gan, Israel) and colleagues.
The retrospective analysis assessed 593,660 adolescents (54.5% males) born since 1975 aged 16–20 years (average age 17.2 years at study entry). They were categorized into six groups based on their BMI, which were underweight (<5th percentile), low-normal BMI (5–49th percentile), high-normal BMI (50–84th percentile), overweight (85–94th percentile), mild obesity (class I; ≥95th percentile to 120% of the 95th percentile), and severe obesity (class II and III; ≥120% of the 95th percentile or BMI ≥35 kg/m2). The proportion of patients in each group were 5.9%, 43.3%, 35.3%, 10.2%, 4.3%, and 1.1%.
During a mean follow-up of 13.4 years, 0.3% of the participants developed early CKD, defined as at least two results with a urine albumin-to-creatinine ratio of 30 mg/g or greater within 6 months of a serum creatinine test and an estimated glomerular filtration rate of 60 mL/min per 1.73 m2or above, which equates to KDIGO stages 1 and 2.
The incidence of early CKD showed a “graded increasing risk from low-normal BMI to severe obesity,” say the researchers.
In male participants, the incidence was 0.17%, 0.15%, 0.25%, 0.51%, 0.78%, and 0.93% for those in the underweight, low-normal BMI, high-normal BMI, overweight, mild obesity, and severe obesity groups as adolescents, respectively. The corresponding rates per 10,000 person–years were 1.25, 1.10, 1.86, 4.10, 6.54, and 8.43.
The respective incidence of early CKD in female participants was 0.38%, 0.31%, 0.41%, 0.68%, 0.79%, and 1.07%, and the corresponding rates per 10,000 person–years were 2.75, 2.24, 3.08, 5.34, 6.53, and 9.64.
The investigators report a steep and significant increase in hazard ratios (HRs) for CKD among male participants, rising from 1.8 in those with high-normal BMI to 4.0 in those who were overweight, 6.7 in those with mild obesity, and 9.4 in those with severe obesity. Among females, the increases in HRs were also significant, at a corresponding 1.4, 2.3, 2.7 and 4.3.
The lower values in females compared with males “are possibly due to the nephroprotective effects of estrogen and to differences in fat distribution,” they say.
Twig et al comment that the findings “underscore the long-term sequelae of adolescent obesity, which may well be evident by the late third or early fourth decades of life.”
They highlight that the increased risk for CKD remained in subgroup analyses where the participants were restricted to adolescents with unimpaired health at baseline and when onset of CKD before 30 years of age was the outcome.
Even in the absence of risk factors such as hypertension or diabetes, the risk for early CKD in young adulthood was “increased by 1.5-to 2.7-fold for persons with overweight and obesity in adolescence,” note Twig and team.
They conclude: “Given the increasing obesity rates among adolescents, our findings are a harbinger of the potentially preventable increasing burden of CKD and subsequent cardiovascular disease.”
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