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Background: Obesity is prevalent in pediatric CKD, but its impact on CKD progression is unclear.

Objective: To determine the relationship between obesity/weight changes with CKD progression among children and adolescents enrolled in the Chronic Kidney Disease in Children (CKiD) study.

Design/Methods: Participants were categorized based on body mass index (BMI) as normal, overweight (OW) or obese and those who were underweight were excluded. Kaplan-Meier survival curves and parametric failure time models determined the association of baseline BMI category on time to KRT stratified by non-glomerular (NG) and glomerular (G) etiology of CKD. The distribution of changes in BMI categories within sequential visit pairs (e.g., obese to OW or OW to normal BMI) and the effect of a one-unit change in BMI category on the annualized change in estimated glomerular filtration rate (eGFR) were determined. Three separate regression models were used for participants with NG and G CKD; each model included all pairs of visits with the same BMI category at the initial visit. Generalized estimating equations, adjusted for age, sex, race, proteinuria and hypertension, were used to account for repeated visit pairs within the same participant.

Results: 160 (27%) of 600 children with NG and 77 (31%) of 246 children with G CKD progressed to KRT. At baseline, 15% of children with NG CKD and 26% of children with G CKD were obese. Times to KRT did not associate with baseline BMI category (Figs 1 and 2). For most, BMI category did not change over time (Figure 3). For those with NG CKD who did not change weight category, there was a similar annualized eGFR change for those who were normal weight, OW and obese. A hypothetical participant with NG CKD who is a 10-year old non-Black female without nephrotic range proteinuria and hypertension and remains obese within a pair of visits has an average annualized eGFR change of -1.0% (95% CI: -3.7%, 1.7%); similar to -1.3% (95% CI: -3.7%, 1.2%) and -0.7% (95% CI: -1.8%, 0.5%) for those who remain OW or normal weight, respectively. Among those with NG CKD who were obese, each decrease in BMI category over time was associated with a concurrent 3.7% increase (95% CI: 0.8%, 6.5%) in annualized eGFR. In those with G CKD, there was no significant difference in annualized change in eGFR by weight category or category change (Fig 4).

Conclusion(s): Baseline obesity does not affect time to KRT, but weight loss in those who are obese may improve kidney survival.

Presented at the 2021 PAS Virtual Conference

Publication Date



Nephrology | Pediatrics

When and Where Presented

Presented at the 2021 PAS Virtual Conference

Obesity does not increase risk for kidney replacement therapy (KRT), but weight reduction improves kidney function in children with chronic kidney disease (CKD)