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Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study

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Abstract

Background

The relationship between protein–energy wasting and chronic kidney disease (CKD) progression is unknown. In the present prospective cohort study, we evaluated the hypothesis that a combination of low body mass index (BMI) and serum albumin level is associated with rapid CKD progression.

Methods

The study cohort comprised 728 predialysis Japanese patients with CKD (stages 2–5) enrolled from 2010 to 2011. Patients were categorized into four groups according to their serum albumin levels and BMI: group 1, low serum albumin level (<4 g/dL) and low BMI (<23.5 kg/m2); group 2, high serum albumin level (≥4 g/dL) and low BMI; group 3, low serum albumin level and high BMI (≥23.5 kg/m2); and group 4, high serum albumin level and high BMI. The primary outcome was a 30 % decline in estimated glomerular filtration rate (eGFR) or start of dialysis within 2 years. The secondary outcome was an annual GFR decline (mL/min/1.73 m2/year).

Results

Logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that only group 1 was associated with a significant risk of CKD progression, with adjusted odds ratio of 3.51 [95 % confidence interval (CI) (1.63, 7.56)]. A multivariate linear regression analysis adjusted for baseline characteristics showed a significant difference in annual eGFR decline between groups 1 and 4 [coefficients β (standard error) −2.62 (0.75), p = 0.001].

Conclusion

This study suggests that combined effects of low BMI (<23.5 kg/m2) and serum albumin level (<4 g/dL) are associated with CKD progression.

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Authors and Affiliations

  1. Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan

    Hiroaki Kikuchi, Shintaro Mandai, Soichiro Iimori, Shotaro Naito, Sei Sasaki, Eisei Sohara, Tomokazu Okado, Tatemitsu Rai & Shinichi Uchida

  2. Department of Nephrology, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo, 153-8934, Japan

    Eiichiro Kanda & Katsuyuki Oi

  3. Department of Nephrology, JA Toride Medical Center, Ibaraki, Japan

    Masanobu Akazawa

  4. Department of Nephrology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan

    Takayuki Toda

  5. Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan

    Teiichi Tamura

  6. Department of Nephrology, Nitobe Memorial Nakano General Hospital, Tokyo, Japan

    Yumi Noda

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  1. Hiroaki Kikuchi
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Correspondence to Eiichiro Kanda.

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Kikuchi, H., Kanda, E., Mandai, S. et al. Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study. Clin Exp Nephrol 21, 55–62 (2017). https://doi.org/10.1007/s10157-016-1251-2

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  • DOI: https://doi.org/10.1007/s10157-016-1251-2

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