Increased Risk of CKD in Metabolically Healthy Overweight and Obese Individuals

Pavankumar Kamat


June 21, 2021


  • Individuals with metabolically healthy overweight or obesity, i.e., without any metabolic risk factors including hypertension, diabetes, dyslipidemia or known cardiovascular diseases, had an increased risk of incident composite chronic kidney disease (CKD) vs those with normal body weight without metabolic abnormalities.

  • This association was stronger in participants aged younger than 65 years.

Why this matters

  • Findings highlight the need for weight loss interventions even in the absence of metabolic abnormalities.

Study details

  • Retrospective, population-based cohort study including 4,447,955 adults across 787 UK general practices identified through The Health Improvement Network database.

  • Participants were classified as:

  • underweight: body mass index (BMI), <18.5 kg/m2;

  • normal weight: BMI, 18.5 to <25 kg/m2;

  • overweight: BMI, 25 to <30 kg/m2; and

  • obesity: BMI, ≥30 kg/m2.

  • Primary outcome: composite incident CKD.

  • Funding: None.

Key results

  • During a mean follow-up of 5.4 years, 114,950 incident composite CKD events were observed.

  • Participants with overweight (adjusted HR [aHR], 1.27; 95% CI, 1.25-1.29) or obesity (aHR, 1.72; 95% CI, 1.70-1.75) vs normal weight had a higher risk of incident composite CKD.

  • Participants who were underweight (aHR, 0.87; 95% CI, 0.83-0.92) vs normal weight had a lower risk of incident CKD.

  • Among participants without metabolic abnormalities, obesity (aHR, 1.66; 95% CI, 1.62-1.70) and overweight (aHR, 1.30; 95% CI, 1.28-1.33) were associated with a higher risk of incident CKD vs normal weight.

  • Association of body size phenotype and metabolic status with composite CKD was stronger in participants aged <65 years vs ≥65 years.


  • Possible misclassification of weight category and metabolic status due to late diagnosis.

  • Risk of residual confounding. 


Wang J, Niratharakumar K, Gokhale K, Tahrani AA, Taverner T, Thomas GN, Dasgupta I. Obesity Without Metabolic Abnormality and Incident CKD: A Population-Based British Cohort Study. Am J Kidney Dis. 2021 Jun 16 [Epub ahead of print]. doi: 10.1053/ j.ajkd.2021.05.008.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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