LOW BMI IS THE RISK OF CARDIO-VASCULAR MORTALITY WITHOUT PROGRESSION OF CKD

The paradoxical risk of BMI on mortality is known in CKD as well in dialysis populations, but studies of CVD risk in CKD including underweight is limited. We hypothesized lean CKD increase the CVD risk, contributing different factors from obese. 2,676 CKD patients recruited from 11 outpatients’ hospitals. BMI and estimated GFR (eGFR) were calculated, and change of eGFR and CVD mortality during 2 years were collected. Patients were divided by BMI under cut off value of normal, thus 7% grouped in lean subjects (BMI <18.5). Systolic blood pressure (sBP), albumin, hemoglobin, age and prevalence of diabetes were lower in lean BMI group compared to other subjects. However CVD history, urinary protein, baseline eGFR and smoking didn't differ between the groups. The lean BMI increased significantly the risk of CVD mortality, in spite of low prevalence of comorbidities and young age in unadjusted model (HR 2.38, 95%CI 1.49-5.21, p<0.01). This significance remained after adjusted for CVD risk factors, such as primary disease of CKD, age, sex, smoking, albumin, cholesterol, sBP and eGFR. On the other hand, BMI was not associated with the decline rate of eGFR. We concluded that BMI less than 18.5 was an independent predictor of CVD, and that BMI did not effect on CKD progression rate in Japanese CKD