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Renal disease

Obese adolescents at risk of ESRD

Patients undergoing dialysis. Obese adolescents stand a higher chance of later developing end-stage renal disease. Photo: Flickr / sswain_1999
Obese adolescents had 19 times the risk for diabetic ESRD

Adolescents who are overweight and obese may have an increased risk of all-cause treated end-stage renal disease (ESRD) over a 25-year period, according to a report published in Archives of Internal Medicine.

"In this long-term nationwide population-based study, overweight and obesity at age 17 years were strongly and positively associated with the incidence of future treated ESRD, although the absolute risk for ESRD remains low," wrote the authors of the study.

Dr Asaf Vivante, Israeli Defense Forces Medical Corps and the Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, and colleagues examined the association between BMI in adolescence and the risk for all-cause, diabetic and non-diabetic ESRD.

Medical data from 1,194,704 adolescents aged 17 years who had been examined for fitness for military service between January 1, 1967, and December 31, 1997, were linked to the Israeli ESRD registry in this nationwide population-based retrospective cohort study. Incident cases of treated ESRD between January 1, 1980, and May 31, 2010 were included.

Cox proportional hazards models were used to estimate the hazard ratio (HR) for treated ESRD among study participants for their BMI at age 17 years, defined in accord with the US Centers for Disease Control and Prevention BMI for age and sex classification.

During 30,478,675 follow-up person-years (mean [SD], 25.51 [8.77] person-years), 874 participants (713 male and 161 female) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100 000 person-years.

Compared with adolescents of normal weight, overweight adolescents (85th to 95th percentiles of BMI) and obese adolescents (≥95th percentile of BMI) had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100 000 person-years, respectively.

In a multivariate model adjusted for sex, country of origin, systolic blood pressure, and period of enrolment in the study, overweight was associated with an HR of 3.00 (95% CI, 2.50-3.60) and obesity with an HR of 6.89 (95% CI, 5.52-8.59) for all-cause treated ESRD.

Overweight (HR, 5.96; 95% CI, 4.41-8.06) and obesity (HR, 19.37; 95% CI, 14.13-26.55) were strong and independent risk factors for diabetic ESRD.

Positive associations of overweight (HR, 2.17; 95% CI, 1.71-2.74) and obesity (HR, 3.41; 95% CI, 2.42-4.79) with non-diabetic ESRD were also documented.

Overweight and obesity in adolescents were associated with significantly increased risk for all-cause treated ESRD during a 25-year period. Elevated BMI constitutes a substantial risk factor for diabetic and non-diabetic ESRD.

The researchers estimated the association between BMI and treated diabetic ESRD and suggest that compared with normal weight adolescents, overweight adolescents at 17 years old had six times the risk for diabetic ESRD and obese adolescents at 17 years old had 19 times the risk for diabetic ESRD.

"Although the results for diabetic ESRD were remarkable, with risks increasing six-fold and 19-fold among overweight and obese adolescents, respectively, our results also indicate a substantial association between elevated BMI and non-diabetic ESRD," the authors wrote.

In an accompanying commentary, Kirsten L Johansen, San Francisco Veterans Affairs Medical Center, said that the study adds the development of ESRD to the list of adverse outcomes associated with adolescent overweight and obesity.

The commentary says that the association of obesity with ESRD is good news and bad news: obesity represents a potentially modifiable risk factor, and control of weight and the hypertension and inactivity that often accompany excess adiposity could prevent or slow the development of some cases of ESRD and may potentially reduce the morbidity and mortality associated with chronic kidney disease; however, it remains difficult to address obesity.

"Although there is no evidence that it is ever too late to improve outcomes by increasing physical activity or shedding excess weight, the results reported by Vivante et al in this issue of the Archives highlight the potential advantages of starting early before chronic disease has developed and unhealthy lifestyles have become lifelong habits," Johansen concludes.

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