The association between variabilities in body mass index (BMI) or metabolic parameters and prognosis of patients with CKD has rarely been studied.

In this retrospective observational study on the basis of South Korea’s national health screening database, we identified individuals who received ≥3 health screenings, including those with persistent predialysis CKD (eGFR <60 ml/min per 1.73 m² or dipstick albuminuria ≥1). The study exposure was variability in BMI or metabolic parameters until baseline assessment, calculated as the variation independent of the mean and stratified into quartiles (with Q4 the highest quartile and Q1 the lowest). We used Cox regression adjusted for various clinical characteristics to analyze risks of all-cause mortality and incident myocardial infarction, stroke, and KRT.

The study included 84,636 patients with predialysis CKD. Comparing Q4 versus Q1, higher BMI variability was significantly associated with higher risks of all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [95% CI], 1.53 to 1.81), P [for trend] <0.001), KRT (HR, 1.20; 95% CI, 1.09 to 1.33; P<0.001), myocardial infarction (HR, 1.19; 95% CI, 1.05 to 1.36, P=0.003), and stroke (HR, 1.19; 95% CI, 1.07 to 1.33, P=0.01). The results were similar in the subgroups divided according to positive or negative trends in BMI during the exposure assessment period. Variabilities in certain metabolic syndrome components (e.g., fasting blood glucose) also were significantly associated with prognosis of patients with predialysis CKD. Those with a higher number of metabolic syndrome components with high variability had a worse prognosis.

Higher variabilities in BMI and certain metabolic syndrome components are significantly associated with a worse prognosis in patients with predialysis CKD.

很少研究体重指数 (BMI) 或代谢参数的变异与 CKD 患者预后之间的关联。

在这项基于韩国国家健康筛查数据库的回顾性观察研究中，我们确定了接受 ≥ 3 次健康筛查的个体，包括患有持续性透析前 CKD（eGFR <60 ml/min/1.73 m ²或试纸蛋白尿 ≥1）的个体。研究暴露是 BMI 或代谢参数的变异性，直到基线评估，计算为独立于平均值的变异并分层为四分位数（Q4 为最高四分位数，Q1 为最低四分位数）。我们使用针对各种临床特征调整的 Cox 回归来分析全因死亡率和心肌梗死、中风和 KRT 事件的风险。

该研究包括 84,636 名透析前 CKD 患者。比较 Q4 与 Q1，较高的 BMI 变异性与较高的全因死亡率风险显着相关（风险比 [HR]，1.66；95% 置信区间 [95% CI]，1.53 至 1.81），P [趋势] <0.001 )、KRT（HR，1.20；95% CI，1.09 至 1.33；P <0.001）、心肌梗死（HR，1.19；95% CI，1.05 至 1.36，P =0.003）和卒中（HR，1.19；95%置信区间，1.07 至 1.33，P = 0.01）。在暴露评估期间，根据 BMI 的积极或消极趋势划分的亚组结果相似。某些代谢综合征成分的变异性（例如., 空腹血糖）也与透析前 CKD 患者的预后显着相关。那些具有较高变异性的代谢综合征成分数量较多的患者预后较差。

BMI 和某些代谢综合征成分的较高变异性与透析前 CKD 患者的较差预后显着相关。