Reflections on chronic kidney disease with obesity-associated(CKD-WO): from an old causal relationship to an approach based on phenotyping

Abstract

Chronic kidney disease (CKD) is a significant public health problem worldwide. The average prevalence worldwide in 2021 was between 11 and 13%, and the mortality associated with CKD is high. It is estimated that By 2040, it will be the fifth cause of death due to all pathologies. One of the risk factors for CKD is obesity, in addition to the classic entities known as diabetes mellitus (DM) and high blood pressure (HTN).

These days, obesity has crossed the limit from an isolated disease to becoming an epidemic; it is estimated that its prevalence in the next decade will increase by 40%. One of the factors that explain this growth is the increase in children with obesity. Obesity is associated with a high healthcare burden derived from the increased risk of various pathological conditions such as DM, HTN, infections, osteoarthritis, and, of course, CKD.

The causal relationship between obesity and CKD has been known for many years. Just as there is a relationship between poverty and kidney failure, there is a relationship between poverty and obesity, with poverty being considered a common risk factor for obesity and chronic kidney disease. Some reports describe that up to 44% of patients with CKD have obesity (21.9% class I obesity, 11.1% class 2 and 3 obesity).

In a recent narrative review titled “Obesity and Chronic Kidney Disease: A Look from the Pathophysiological Mechanisms,” we described the different mechanisms of action that involve obesity with the onset and development of CKD, finding common and uncommon pathophysiological mechanisms. That relates to obesity as a cause of CKD. Derived from this review, we found that not all patients with CKD associated with obesity (CKD-AO) are the same, and four phenotypes are established, of which 3 of them occur in patients with CKD who are not on obesity therapies. Renal support (RST) and type 4 in patients with CKD-AO who are on dialysis, which has a “J” curve phenomenon where in patients with CKD without dialysis, obesity is a risk factor. It is associated with decreased survival, while in patients who are in kidney function replacement programs, obesity is a protective factor associated with a nutritional status that allows mortality to be reduced in patients in dialysis programs.