Body Weight Variability and the Risk of End-Stage Renal Disease in Korea: A Nationwide Cohort Study

초록

Background: This study aimed to examine the association of weight variability with the risk of End-Stage Renal Disease (ESRD) in the Korean population. Methods: A total of 2,310,667 participants, who were 40 years or older and had participated in at least two health examinations of the Korean National Health Insurance Services between 2009 and 2012, were analyzed. Body weight was recorded and Average Real Variability (ARV), divided into quartiles (Q), represented the fluctuations in weight. Multivariable Cox proportional hazard models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of ESRD, according to Body Mass Index (BMI) and weight ARV. Results: After a mean follow-up of 4.4 years, 1663 (0.07%) new cases of ESRD were evident. Participants with BMI ≥30 showed decreased risk of ESRD (HR = 0.63, 95% CI: 0.43–0.94) compared with BMI 18.5–23. Compared with BMI 18.5–23, higher BMI (23–25, 25–30, or ≥ 30) was associated with lower risk of ESRD. However, weight ARV Q4 (highest variability) displayed increased risk for ESRD (HR = 1.42, 95% CI: 1.25–1.61) compared with weight ARV Q1 (lowest variability). Among weight ARV Q4, higher risks of ESRD were reported in the subgroups of men (HR = 1.372, 95% CI: 1.23–1.54), age < 65 (HR = 1.34, 95% CI: 1.19–1.51), and age ≥ 65 (HR = 1.36, 95% CI: 1.12–1.65) compared with weight ARV Q1 to Q3. In weight ARV Q4, increased risk of ESRD were shown in the subgroups of weight gain (HR = 1.22, 95% CI: 1.06–1.41) and weight-sustained (HR = 1.49, 95% CI: 1.14–1.95) compared with weight ARV Q1 to Q3. Moreover, the risk of ESRD remained persistently elevated in weight ARV Q4, irrespective of fluctuations in serum creatinine levels. Conclusions: Patients with weight variability may have an increased risk of ESRD. Prompt weight loss and weight loss maintenance should be considered in this population.