J Korean Med Sci.  2024 Jan;39(3):e12. 10.3346/jkms.2024.39.e12.

The Impact of Obesity on Kidney Disease: Observational Cohort Study Analyzing 14,492 Kidney Biopsy Cases

• Kim TB
• Ahn SY
• Oh J
• Bae EH
• Chin HJ
• Kim MG
• Jo SK
• Cho WY
• Oh SW

• KMID: 2551174
• DOI: http://doi.org/10.3346/jkms.2024.39.e12

Abstract

Background
The obesity epidemic is associated with the emergence of new kidney diseases including obesity-related glomerulopathy (ORG) and metabolic syndrome-associated disorders. However, the effects of obesity on prevalence and outcome of biopsy-proven kidney disease are not well known.
Methods
We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea. Obesity was defined as a body mass index value of ≥ 30 kg/m ² .
Results
The most common disease was IgA nephropathy (IgAN) in both obese and nonobese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37–2.17; OR, 1.96, 95% CI, 1.21–3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62–0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01–2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36–8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09–5.64).
Conclusion
Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.

Keyword

Chronic Kidney Disease; End Stage Kidney Disease; Glomerular Disease; Kidney Biopsy; Obesity; Obesity-Related Glomerulopathy

Figure

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  Fig. 1 Selection of the study population.BMI = body mass index.

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  Fig. 2 Prevalence of obesity in participants undergoing kidney biopsies from 1979–1988 to 2009–2018.

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  Fig. 3 Prevalence of kidney disease confirmed by pathology according to obesity.BMI = body mass index, IgAN = IgA nephropathy, FSGS = focal segmental glomerulosclerosis, MCD = minimal change disease, MN = membranous nephropathy, DMN = diabetic nephropathy, LN = lupus nephritis, HT-N = hypertensive nephropathy, MPGN = membranoproliferative glomerulonephritis, C3G = complement 3 glomerulopathy, ATN = acute tubular necrosis.

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