Weight fluctuations contribute to adverse outcomes in patients with CKD
Rapid weight gain and loss are linked with a high risk of adverse outcomes in patients with chronic kidney disease, according to a study.
“To the best of our knowledge, this is the first report suggesting that rapid weight change over time, either weight loss or gain beyond a certain range, is independently associated with increased risk of [end-stage renal disease] ESRD and composite of [cardiovascular disease] CVD and mortality in patients with CKD,” Hyunjin Ryu, MD, MS, from the department of internal medicine at Seoul National University Hospital, and colleagues wrote.
In this multicenter prospective cohort study, researchers collected longitudinal data from 2,022 patients. They calculated percent weight change per year using regression analysis. Patients were grouped into the following five categories: group 1 included equal to or less than –5% weight change per year; group 2 had –5% to less than –2.5% per year; group 3 had –2.5% to less than 2.5% per year; group 4 had 2.5% to less than 5% per year; and group 5 had equal to or greater than 5% per year. Data were also calculated for incidences of ESRD, composite outcomes of CVD and death in each group.
The mean follow-up was 4.4 years. During that time, investigators found 414 ESRD and 188 composite CVD and mortality events. Researchers found both weight gain and loss were independent risk factors for adverse outcomes in patients. Groups 1, 2, 4 and 5 displayed significantly increased HRs for developing ESRD compared with group 3. There was a U-shaped correlation between the degree of longitudinal weight change and ESRD (HRs of 3.61, 2.15, 1.86 and 3.66 for groups 1, 2, 4 and 5, respectively) and composite of CVD and death (HRs 2.92, 2.15, 1.73 and 2.54, respectively), according to the researchers.
They noted the study lacked information on whether weight fluctuation was intentional in patients.
“The effects of weight loss or gain were equally harmful, although weight loss showed slightly higher HRs compared to the same degree of weight gain,” Ryu and colleagues wrote. “Both rapid weight gain and loss can result in a decreased muscle to fat ratio and
this imbalance between lean mass and fat mass likely influences the adverse outcomes in patients with CKD.”