Hypertension, diabetes, and central obesity as risk factors for chronic kidney disease in class II and III obesity patients.

BACKGROUND: Obese patients are at risk for chronic kidney disease (CKD). The high prevalence of hypertension and diabetes is central to the pathogenesis of kidney disease in these patients. In addition, specific factors such as age, central obesity, and the duration of obesity may also play a role. The present study examined the effects of these factors on the development of renal disease in a population of obese patients regularly followed in an outpatient program. METHODS: Obese patients in classes II-III were recruited from an obesity treatment program. Patients were grouped into CKD and non-CKD. Age, HbA1c, duration of obesity, urine albumin-to-creatinine ratio (uACR), and anthropometric data, including body weight, waist circumference, neck circumference, BMI, a body shape index (ABSI), and conicity index (CI), were correlated with eGFR. Odds ratios for CKD were examined for hypertension and diabetes, both crude and adjusted for age, gender, and race. RESULTS: Among 202 patients, the prevalence of CKD was 19.8%. Body weight, waist circumference, neck circumference, and BMI were not correlated with renal function. However, age, HbA1c, uACR, duration of obesity, and central obesity parameters, such as ABSI and CI, were significantly and inversely correlated with eGFR, while HbA1c levels were positively correlated with uACR. The odds ratio for CKD was 12.3 for hypertensives and 4.0 for diabetics, adjusted for age, race, and gender. CONCLUSIONS: In this population of obese patients, systemic arterial hypertension confers the highest risk for CKD, followed by diabetes. Central obesity, as measured by ABSI and CI, was inversely correlated with renal function.