Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

被引：86

作者：

Ahmadi, Seyed-Foad ^{[1
,2
]}

Zahmatkesh, Golara ^{[1
]}

Ahmadi, Emad ^{[4
]}

Streja, Elani ^{[1
,5
]}

Rhee, Connie M. ^{[1
]}

Gillen, Daniel L. ^{[2
,3
,6
]}

De Nicola, Luca ^{[10
]}

Minutolo, Roberto ^{[10
]}

Ricardo, Ana C. ^{[7
]}

Kovesdy, Csaba P. ^{[8
,9
]}

Kalantar-Zadeh, Kamyar ^{[1
,2
,5
,6
]}

机构：

[1] Univ Calif Irvine, Harold Simmons Ctr Kidney Dis Res & Epidemiol, Div Nephrol & Hypertens, Med Ctr, 101 City Dr South,City Tower, Orange, CA 92868 USA

[2] Univ Calif Irvine, Dept Populat Hlth & Dis Prevent, Program Publ Hlth, Irvine, CA USA

[3] Univ Calif Irvine, Donald Bren Sch Informat & Comp Sci, Dept Stat, Irvine, CA USA

[4] Harvard Univ, Sch Med, Dept Radiol, Massachusetts Gen Hosp, Boston, MA 02115 USA

[5] Vet Affairs Long Beach Healthcare Syst, Long Beach, CA USA

[6] Univ Calif Los Angeles, Sch Publ Hlth, Dept Epidemiol, Los Angeles, CA 90024 USA

[7] Univ Illinois, Dept Med, Div Nephrol, Chicago, IL USA

[8] Univ Tennessee, Ctr Hlth Sci, Div Nephrol, Memphis, TN 38163 USA

[9] Memphis Vet Affairs Med Ctr, Memphis, TN USA

[10] Univ Naples 2, Nephrol Div, Naples, Italy

来源：

CARDIORENAL MEDICINE | 2016年 / 6卷 / 01期

关键词：

Chronic kidney disease; Body mass index; Mortality; End-stage renal disease; Obesity paradox; ALL-CAUSE MORTALITY; CARDIOVASCULAR RISK-FACTORS; OBESITY PARADOX; PERITONEAL-DIALYSIS; CKD; HEMODIALYSIS; POPULATION; OVERWEIGHT; SURVIVAL; FAILURE;

D O I：

10.1159/000437277

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Previous studies have not shown a consistent link between body mass index (BMI) and outcomes such as mortality and kidney disease progression in non-dialysis-dependent chronic kidney disease (CKD) patients. Therefore, we aimed to complete a systematic review and meta-analysis study on this subject. Methods: We searched MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Co-chrane Central Register of Controlled Trials (CENTRAL), and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa quality assessment scale. We meta-analyzed the results based on the BMI classification system by the WHO. Results: We included 10 studies (with a total sample size of 484,906) in the systematic review and 4 studies in the meta-analyses. The study results were generally heterogeneous. However, following reanalysis of the largest reported study and our meta-analyses, we observed that in stage 3-5 CKD, being underweight was associated with a higher risk of death while being overweight or obese class I was associated with a lower risk of death; however, obesity classes II and III were not associated with risk of death. In addition, reanalysis of the largest available study showed that a higher BMI was associated with an incrementally higher risk of kidney disease progression; however, this association was attenuated in our pooled results. For earlier stages of CKD, we could not complete meta-analyses as the studies were sparse and had heterogeneous BMI classifications and/or referent BMI groups. Conclusion: Among the group of patients with stage 3-5 CKD, we found a differential association between obesity classes I-III and mortality compared to the general population, indicating an obesity paradox in the CKD population. (C) 2015 S. Karger AG, Basel

引用

页码：37 / 49

页数：13

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