High Body Mass Index Reduces Glomerular Filtration Rate Decline in Type II Diabetes Mellitus Patients With Stage 3 or 4 Chronic Kidney Disease

摘要

Abstract: Whether high body mass index (BMI) has an effect on progressive diabetic nephropathy in type II diabetes mellitus (DM) patients with chronic kidney disease (CKD) stage 3 or 4 remains unclear. This prospective study aimed to investigate the relationship between BMI and progression of renal function deterioration in type II DM patients with CKD stage 3 or 4. A total of 105 type II DM patients with CKD stage 3 or 4 participated in this 24-month prospective observational study. Patients were divided into 3 groups according to BMI as follows: normal group, BMI of 18.5–22.9?kg/m2; overweight group, BMI of 23–24.9?kg/m2; and obese group, BMI of ≥25?kg/m2. The primary end point was a 2-fold elevation in serum creatinine levels (measured twice with a 1-month interval) from baseline values, need for long-term dialysis, or death during the 24-month observation period. In the linear regression analysis with the stepwise method, each 1?kg/m2 increase in BMI led to an increase of 0.32?mL?min?1?×?1.73?m?2 in the estimated glomerular filtration rate (95% confidence interval, CI, 0.01–0.62; P?=?0.04) during the 24-month study period. Moreover, multivariate Cox regression analysis showed that compared with the obese group, the normal BMI group (hazard ratio?=?2.76, 95% CI?:?1.27–6; P?=?0.01) achieved the primary outcome after adjusting for other factors. In this 24-month prospective observational study, we showed that BMI of ≥25?kg/m2 was a protective factor for renal function deterioration in type II DM patients with CKD stage 3 or 4.