Higher BMI predicts adverse renal events in type 2 diabetes
Higher body mass index (BMI) appears to be independently associated with the risk of renal disease among patients with type 2 diabetes (T2D), a study has shown.
Researchers evaluated the relationship between BMI and the risk of major renal events in 10,537 T2DM patients (mean age 66 years; 58 percent male; mean diabetes duration, 8 years) enrolled in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study.
Of the patients, 58 were underweight (BMI <18.5 kg/m2), 2,894 were of normal weight (BMI ≥18.5 to <25 kg/m2), 4,340 were overweight (BMI ≥25 to <30 kg/m2), 2,265 had grade 1 obesity (BMI ≥30 to <35 kg/m2), 744 had grade 2 obesity (BMI ≥35 to <40 kg/m2) and 294 had grade 3 obesity (BMI ≥40 kg/m2). Those who were underweight were excluded in the analysis.
During the 5-year follow-up, a total of 487 T2D patients (4.6 percent) developed major renal events (defined as development of new macroalbuminuria, doubling of creatinine, end-stage renal disease or renal death). On multivariable Cox analysis, the risk increased with increasing BMI. The hazard ratios (HRs) for major renal event were 0.91 (95 percent CI, 0.72–1.15) in overweight patients, 1.03 (0.77–1.37) in those with grade 1 obesity, 1.42 (0.98–2.07) in those with grade 2 and 2.16 (1.34–3.48) in those with grade 3 (p=0.006).
The elevated major renal event risk observed with greater BMI was observed across subgroups by randomized interventions (intensive vs standard glucose control and perindopril-indapamide vs placebo). Every additional unit of BMI over 25 kg/m2 was associated with a 4-percent increase in the risk of major renal events.
Similar results were observed for the secondary endpoints of the development of new microalbuminuria and the individual components of the composite of major renal adverse events.
The present data encourage comprehensive and motivated weight loss programmes for improving the prevention of the development and progression of kidney complications in patients with both T2D and obesity, researchers said.