Kidney Week

Abstract: FR-PO1113

Long-Term Dynamic Effect of Body Mass Index on Adverse Cardiovascular Outcomes with the Targeted Maximum Likelihood Estimation Method: Results from the KNOW-CKD Study

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Oh, Yun Jung, H Plus Yangji Hospital, Seoul, Korea (the Republic of)

Yun Jung Oh, MD, PhD

• Oh, Kook-Hwan, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Kook-Hwan Oh, MD, PhD

• Chung, Wookyung, Gachon University Gil Medical Center, Incheon, Korea (the Republic of)

Wookyung Chung, MD

• Jung, Ji Yong, Gachon University Gil Medical Center, Incheon, Korea (the Republic of)

Ji Yong Jung, MD, PhD

Background

Unlike the general population, the obesity paradox, referring to the association of high body mass index (BMI) with better survival, has been observed in patients with chronic kidney disease (CKD). However, the impact of long-term BMI changes in CKD patients on the risk of cardiovascular outcomes considering time varying exposure and confounding, has been rarely studied.

Methods

A total of 1,061 patients enrolled as part of The Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed at 3 observational points (baseline, 3-year; early, and 7-year; late) at which BMI was measured. We used longitudinal targeted minimum loss-based estimation (TMLE) and marginal structural models (MSM) to estimate the cumulative incidence of cardiovascular events (CVEs) of dynamic exposure to high BMI (≥23kg/m²) comparing counterfactuals (BMI <23kg/m²) adjusted for time varying confounding (systolic blood pressure, estimated glomerular filtration rate) and baseline covariates (age, sex, smoking, diabetes, cardiovascular disease, and proteinuria).

Results

Patients with sustained high BMI throughout 7-year follow-up had significantly reduced risk of CVEs than those with counterfactuals (relative risk [RR], 0.279; 95% confidence interval, 0.143-0.546; P < 0.001). However, the RR were 0.319 (0.001-136.9; P = 0.712) and 0.988 (0.296-3.298; P = 0.985) for early and late change to high BMI comparing sustained low BMI, respectively. In MSM, hazard ratio (HR) of accumulative high BMI frequency were 0.925 (0.663-2.189; P = 0.645) up to 3 years and 0.562 (0.406-0.779; P = 0.001) up to 7 years, respectively.

Conclusion

In CKD patients, higher BMI is associated with better cardiovascular outcome, and the protective effect is observed only in patients who retained high BMI consistently over long-term period.

Funding

• Government Support – Non-U.S.