Table 1: Studies examining the association of obesity with various measures of CKD.

Study Patients Exposure Outcomes Results Comments
Prevention of renal and vascular end-stage disease (PREVEND) Study [9] 7,676 Dutch individuals without diabetes Elevated BMI (overweight and obese*), and central fat distribution (waist-hip ratio) Presence of urine albumin 30-300 mg/24 h Obese + central fat: higher risk of albuminuria Cross sectional analysis
Elevated and diminished GFR Obese ± central fat: higher risk of elevated GFR
Central fat ± obesity associated with diminished filtration
Multinational study of hypertensive outpatients [21] 20,828 patients BMI and waist circumference Prevalence of albuminuria by dip stick Higher waist circumference associated with albuminuria independent of BMI Cross sectional analysis
From 26 countries
Framingham multi-detector computed tomography (MDCT) cohort [23] 3,099 individuals Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) Prevalence of UACR > 25 mg/g in women and > 17 mg/g in men VAT associated with albuminuria in men, but not in women Cross sectional analysis
CARDIA (coronary artery risk development in young adults) study [12] 2,354 community-dwelling individuals with normal kidney function aged 28-40 years Obesity (BMI > 30 kg/m2) Incident microalbuminuria Obesity (OR 1.9) and unhealthy diet (OR 2.0) associated with incident albuminuria Low number of events
Diet and lifestyle-related factors
Hypertension detection and follow-up program [11] 5,897 hypertensive adults Overweight and obese BMI* vs. normal BMI Both overweight (OR 1.21) and obesity (OR 1.40) associated with incident CKD Results unchanged after excluding diabetics
Framingham offspring study [10] 2,676 individuals free of CKD stage 3 High vs. normal BMI* Incident CKD stage 3 Higher BMI not associated with CKD3 after adjustments Predominantly white, limited geography
Incident proteinuria Higher BMI associated with increased odds of incident proteinuria
Physicians' health study [14] 11,104 initially healthy men in US BMI quintiles Incident eGFR < 60 mL/min/1.73 m2 Higher baseline BMI and increase in BMI over time both associated with higher risk of incident CKD Exclusively men
Increase in BMI over time (vs. stable BMI)
Nation-wide US veterans administration cohort [15] 3,376,187 US veterans with baseline eGFR ≥ 60 mL/min/1.73 m2 BMI categories from < 20 to > 50 kg/m2 Rapid decline in kidney function (negative eGFR slope of > 5 mL/min/1.73 m2) BMI > 30 kg/m2 associated with rapid loss of kidney function Associations more accentuated in older individuals
Nation-wide population-based study from Sweden [13] 926 Swedes with moderate/advanced CKD compared to 998 controls BMI ≥ 25 vs. < 25 kg/m2 CKD vs. no CKD Higher BMI associated with 3x higher risk of CKD Risk strongest in diabetics, but also significantly higher in non-diabetics
Nation-wide population based study in Israel [18] 1,194,704 adolescent males and females examined for military service Elevated BMI (overweight and obesity) vs. normal BMI* Incident ESRD Overweight (HR 3.0) and obesity (HR 6.89) associated with higher risk of ESRD Associations strongest for diabetic ESRD, but also significantly higher for non-diabetic ESRD
The Nord-Trøndelag health study (HUNT-1) [16] 74,986 Norwegian adults BMI categories* Incidence of ESRD or renal death BMI > 30 kg/m2 associated with worse outcomes Associations not present in individuals with BL < 120/80 mmHg
Community-based screening in Okinawa, Japan [17] 100,753 individuals > 20 years old BMI quartiles Incidence of ESRD Higher BMI associated with increased risk of ESRD in men, but not in women Average BMI lower in Japan compared to western countries
Nation-wide US veterans administration cohort [20] 453,946 US veterans with baseline eGFR < 60 ml/min per 1.73 m2 BMI categories from < 20 to > 50 kg/m2 Incidence of ESRD Moderate and severe obesity associated with worse renal outcomes Associations present but weaker in patients with more advanced CKD
Doubling of serum creatinine
Slopes of eGFR
Kaiser permanente northern california [19] 320,252 adults with and without baseline CKD Overweight, class I, II and extreme obesity; vs. normal BMI* Incidence of ESRD Linearly higher risk of ESRD with higher BMI categories Associations remained present after adjustment for DM, hypertension and baseline CKD
REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study [22] 30,239 individuals Elevated waist circumference or BMI Incidence of ESRD BMI above normal not associated with ESRD after adjustment for waist circumference Association of waist circumference with ESRD became on-significant after adjustment for comorbidities and baseline eGFR and proteinuria
Higher waist circumference associated with ESRD

*Normal weight: BMI 18.5 to 24.9 kg/m2; Over weight: BMI 25.0 to 29.9 kg/m2; Class I obesity: BMI 30.0 to 34.9 kg/m2; class II obesity: BMI 35.0 to 39.9 kg/m2; class III obesity: BMI ≥ 40 kg/m2; BMI: body mass index; CKD: chronic kidney disease; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; ESRD: end stage renal disease; HR: hazard ratio; OR: odds ratio; UACR: urine albumin-creatinine ratio.