Overweight Teens at Higher Risk for ESRD

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Overweight and obese adolescents are at increased risk for end-stage renal disease (ESRD), according to Israeli researchers.

In a nationwide population-based retrospective study, Asaf Vivante, MD, of the Israeli Defense Forces Medical Corps and Sheba Medical Center, Tel Hashomer, and colleagues analyzed data from 1,194 adolescents aged 17 years who had been examined for fitness for military service between January 1, 1967 and December 31, 1997. These data were linked to the Israeli ESRD registry. The investigators included in their analysis incident cases of treated ESRD from January 1, 1980 to May 31, 2010.

During a mean of about 25 years of follow-up, treated ESRD developed in 874 subjects (713 male and 161 female). Compared with individuals of normal weight, overweight was associated with threefold increased risk for all-cause treated ESRD and obesity was associated with a nearly sevenfold increased risk, after adjusting for gender, country of origin, systolic blood pressure, and period of enrollment in the study, Dr. Vivante's team reported in Archives of Internal Medicine (2012;172:1644-1650). Overweight and obesity were associated with a sixfold and 19-fold increased risk for diabetic ESRD, respectively, and a twofold and threefold increased risk for nondiabetic ESRD.

The investigators considered adolescents overweight if they were in the 85th to 95th percentile of body mass index (BMI) and obese if they were in the 95th or greater percentile of BMI.

Dr. Vivante's team noted that study strengths included the use of a large nationwide cohort that included both genders and detailed clinical assessment parameters, as well as a long follow-up period and comprehensive documentation of ESRD. With respect to study limitations, they stated that subjects' body weight and height were measured only once. “Therefore, the effects of weight loss on risk for ESRD during the follow-up period could not be determined,” they noted. In addition, subjects' glomerular filtration rates at enrollment were unavailable. “Consequently, some participants who subsequently developed treated ESRD may have had asymptomatic or undetected early-stage CKD.” The authors, however, pointed out that CKD is rare in individuals aged 17 years.

In an accompanying editorial, Kirsten L. Johansen, MD, of the University of California-San Francisco, noted that the association of obesity with ESRD is both good and bad news. The good news is that obesity is a potentially modifiable risk factor. Control of weight and the hypertension and inactivity that often accompany excess adiposity, she wrote, could prevent or slow development of some cases of ESRD and may potentially decrease the morbidity and mortality associated with chronic kidney disease. The bad news, she pointed out, is that it is not easy to address obesity.

In addition, Dr. Johansen observed: “The strong association between obesity at age 17 and the incidence of ESRD many years later underscores the fact that overweight adolescent generally go on to become overweight adults.”

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