Original Study| Volume 22, ISSUE 8, P1751-1756.e2, August 2021

Incremental Effect of Aging on Obesity-Related Incident Chronic Kidney Disease in the Korean General Population

Published:November 22, 2020DOI:



      Obesity may increase the risk of kidney function decline. However, few studies have addressed how age modifies obesity-associated risk of chronic kidney disease (CKD) in the Asian general population.


      A community-based prospective cohort study.

      Setting and Participants

      6538 Korean general population with normal kidney function from the Korean Genome and Epidemiology Study Database.


      Participants were stratified according to age (40–49, 50–59, and 60-69 years old) and body mass index [≥18.5–<23 (normal-weight), ≥23–<27.5 (overweight), and ≥27.5 (obese)]. We conducted Kaplan-Meier and multivariable-adjusted Cox regression analyses to investigate the association of aging and obesity with incident CKD.


      During the 12-year follow-up, an overall incidence rate of CKD was 6.1 cases per 1000 person-years. Obese, but not overweight, people had an increased risk of incident CKD compared with normal-weight people in multivariable models adjusted for metabolic factors. When analyzed by 10-year increments, this association was significant only in 60-69-year-old individuals. Kaplan-Meier analysis showed that the incidence of CKD associated with overweight or obesity showed an accentuated increase with age. With reference to normal-weight individuals aged 40-49 years, the adjusted hazard ratio of CKD increased with age regardless of body mass index, and the positive association between obesity and incident CKD was more prominent with increasing age.

      Conclusions and Implications

      Obesity-associated risk of incident CKD was accentuated in older people, and this association was independent of metabolic abnormalities.


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        • World Health Organization
        Prevalence of obesity among adults, BMI ≥ 30, age-standardized estimates by WHO region.
        (Available at:
        Date: 2017
        Date accessed: April 12, 2020
        • Gelber R.P.
        • Kurth T.
        • Kausz A.T.
        • et al.
        Association between body mass index and CKD in apparently healthy men.
        Am J Kidney Dis. 2005; 46: 871-880
        • Jung C.H.
        • Lee M.J.
        • Kang Y.M.
        • et al.
        The risk of chronic kidney disease in a metabolically healthy obese population.
        Kidney Int. 2015; 88: 843-850
        • Foster M.C.
        • Hwang S.J.
        • Larson M.G.
        • et al.
        Overweight, obesity, and the development of stage 3 CKD: The Framingham heart study.
        Am J Kidney Dis. 2008; 52: 39-48
        • Stenvinkel P.
        • Zoccali C.
        • Ikizler T.A.
        Obesity in CKD—What should nephrologists know?.
        J Am Soc Nephrol. 2013; 24: 1727-1736
        • Lindeman R.D.
        • Tobin J.
        • Shock N.W.
        Longitudinal studies on the rate of decline in renal function with age.
        J Am Geriatr Soc. 1985; 33: 278-285
        • Pottel H.
        • Delanaye P.
        • Weekers L.
        • et al.
        Age-dependent reference intervals for estimated and measured glomerular filtration rate.
        Clin Kidney J. 2017; 10: 545-551
        • Schmitt R.
        • Coca S.
        • Kanbay M.
        • et al.
        Recovery of kidney function after acute kidney injury in the elderly: A systematic review and meta-analysis.
        Am J Kidney Dis. 2008; 52: 262-271
        • Fleischmann E.
        • Teal N.
        • Dudley J.
        • et al.
        Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients.
        Kidney Int. 1999; 55: 1560-1567
        • Neeland I.J.
        • Das S.R.
        • Simon D.N.
        • et al.
        The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: Results from the NCDR.
        Eur Heart J Qual Care Clin Outcomes. 2017; 3: 183-191
        • Horwich T.B.
        • Fonarow G.C.
        • Hamilton M.A.
        • et al.
        The relationship between obesity and mortality in patients with heart failure.
        J Am Coll Cardiol. 2001; 38: 789-795
        • Kovesdy C.P.
        • Anderson J.E.
        • Kalantar-Zadeh K.
        Paradoxical association between body mass index and mortality in men with CKD not yet on dialysis.
        Am J Kidney Dis. 2007; 49: 581-591
        • Wu S.
        • Yang Y.M.
        • Zhu J.
        • et al.
        Impact of age on the association between body mass index and all-cause mortality in patients with atrial fibrillation.
        J Nutr Health Aging. 2017; 21: 1125-1132
        • Berrington de Gonzalez A.
        • Hartge P.
        • Cerhan J.R.
        • et al.
        Body-mass index and mortality among 1.46 million white adults.
        N Engl J Med. 2010; 363: 2211-2219
        • Bowman K.
        • Delgado J.
        • Henley W.E.
        • et al.
        Obesity in older people with and without conditions associated with weight loss: Follow-up of 955,000 primary care patients.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 203-209
        • Stevens J.
        • Cai J.
        • Pamuk E.R.
        • et al.
        The effect of age on the association between body-mass index and mortality.
        N Engl J Med. 1998; 338: 1-7
        • Mattila K.
        • Haavisto M.
        • Rajala S.
        Body mass index and mortality in the elderly.
        Br Med J (Clin Res Ed). 1986; 292: 867-868
        • Rajala S.A.
        • Kanto A.J.
        • Haavisto M.V.
        • et al.
        Body weight and the three-year prognosis in very old people.
        Int J Obes. 1990; 14: 997-1003
        • Kalmijn S.
        • Curb J.D.
        • Rodriguez B.L.
        • et al.
        The association of body weight and anthropometry with mortality in elderly men: The Honolulu heart program.
        Int J Obes Relat Metab Disord. 1999; 23: 395-402
        • Grabowski D.C.
        • Ellis J.E.
        High body mass index does not predict mortality in older people: Analysis of the longitudinal study of aging.
        J Am Geriatr Soc. 2001; 49: 968-979
        • Lu J.L.
        • Molnar M.Z.
        • Naseer A.
        • et al.
        Association of age and BMI with kidney function and mortality: A cohort study.
        Lancet Diabetes Endocrinol. 2015; 3: 704-714
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • Razak F.
        • Anand S.S.
        • Shannon H.
        • et al.
        Defining obesity cut points in a multiethnic population.
        Circulation. 2007; 115: 2111-2118
        • Norris K.C.
        • Agodoa L.Y.
        Unraveling the racial disparities associated with kidney disease.
        Kidney Int. 2005; 68: 914-924
        • Jolly S.E.
        • Burrows N.R.
        • Chen S.C.
        • et al.
        Racial and ethnic differences in albuminuria in individuals with estimated GFR greater than 60 mL/min/1.73 m2: Results from the Kidney Early Evaluation Program (KEEP).
        Am J Kidney Dis. 2010; 55: S15-S22
        • Derose S.F.
        • Rutkowski M.P.
        • Crooks P.W.
        • et al.
        Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system.
        Am J Kidney Dis. 2013; 62: 236-244
        • Thomas M.C.
        • Cooper M.E.
        • Zimmet P.
        Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease.
        Nat Rev Nephrol. 2016; 12: 73-81
        • Lin C.
        • Yang H.Y.
        • Wu C.C.
        • et al.
        Angiotensin-converting enzyme insertion/deletion polymorphism contributes high risk for chronic kidney disease in Asian male with hypertension—A meta-regression analysis of 98 observational studies.
        PLoS One. 2014; 9: e87604
        • Kim Y.
        • Han B.G.
        • KoGES Group
        Cohort profile: The Korean Genome and epidemiology study (KoGES) consortium.
        Int J Epidemiol. 2017; 46: e20
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).
        JAMA. 2001; 285: 2486-2497
        • Chang Y.
        • Ryu S.
        • Choi Y.
        • et al.
        Metabolically healthy obesity and development of chronic kidney disease: A cohort study.
        Ann Intern Med. 2016; 164: 305-312
        • Chang A.R.
        • Grams M.E.
        • Ballew S.H.
        • et al.
        Adiposity and risk of decline in glomerular filtration rate: Meta-analysis of individual participant data in a global consortium.
        BMJ. 2019; 364: k5301
        • Deurenberg P.
        • Yap M.
        • van Staveren W.A.
        Body mass index and percent body fat: A meta analysis among different ethnic groups.
        Int J Obes Relat Metab Disord. 1998; 22: 1164-1171
        • Thomas G.
        • Sehgal A.R.
        • Kashyap S.R.
        • et al.
        Metabolic syndrome and kidney disease: A systematic review and meta-analysis.
        Clin J Am Soc Nephrol. 2011; 6: 2364-2373
        • Muntner P.
        • Coresh J.
        • Smith J.C.
        • et al.
        Plasma lipids and risk of developing renal dysfunction: The atherosclerosis risk in communities study.
        Kidney Int. 2000; 58: 293-301
        • Chen J.
        • Muntner P.
        • Hamm L.L.
        • et al.
        The metabolic syndrome and chronic kidney disease in U.S. adults.
        Ann Intern Med. 2004; 140: 167-174
        • Chen J.
        • Muntner P.
        • Hamm L.L.
        • et al.
        Insulin resistance and risk of chronic kidney disease in nondiabetic US adults.
        J Am Soc Nephrol. 2003; 14: 469-477
        • Wahba I.M.
        • Mak R.H.
        Obesity and obesity-initiated metabolic syndrome: Mechanistic links to chronic kidney disease.
        Clin J Am Soc Nephrol. 2007; 2: 550-562
        • Chagnac A.
        • Weinstein T.
        • Korzets A.
        • et al.
        Glomerular hemodynamics in severe obesity.
        Am J Physiol Renal Physiol. 2000; 278: F817-F822
        • Tsuboi N.
        • Utsunomiya Y.
        • Kanzaki G.
        • et al.
        Low glomerular density with glomerulomegaly in obesity-related glomerulopathy.
        Clin J Am Soc Nephrol. 2012; 7: 735-741
        • Praga M.
        • Hernandez E.
        • Herrero J.C.
        • et al.
        Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy.
        Kidney Int. 2000; 58: 2111-2118
        • Gonzalez E.
        • Gutierrez E.
        • Morales E.
        • et al.
        Factors influencing the progression of renal damage in patients with unilateral renal agenesis and remnant kidney.
        Kidney Int. 2005; 68: 263-270
        • Nyengaard J.R.
        • Bendtsen T.F.
        Glomerular number and size in relation to age, kidney weight, and body surface in normal man.
        Anat Rec. 1992; 232: 194-201
        • Yang Y.
        • Dugue P.A.
        • Lynch B.M.
        • et al.
        Trajectories of body mass index in adulthood and all-cause and cause-specific mortality in the Melbourne Collaborative Cohort Study.
        BMJ Open. 2019; 9: e030078
        • Islam M.T.
        • Moller J.
        • Zhou X.
        • et al.
        Life-course trajectories of body mass index and subsequent cardiovascular risk among Chinese population.
        PLoS One. 2019; 14: e0223778
        • Cleland V.
        • Tian J.
        • Buscot M.J.
        • et al.
        Abstract MP66: Body mass index trajectories from childhood to adulthood: Evidence from the International childhood cardiovascular cohort (i3C) consortium.
        Circulation. 2019; 139: AMP66
        • Silverwood R.J.
        • Pierce M.
        • Thomas C.
        • et al.
        Association between younger age when first overweight and increased risk for CKD.
        J Am Soc Nephrol. 2013; 24: 813-821
        • McMahon G.M.
        • Preis S.R.
        • Hwang S.J.
        • et al.
        Mid-adulthood risk factor profiles for CKD.
        J Am Soc Nephrol. 2014; 25: 2633-2641