Metabolically healthy obesity and incident chronic kidney disease: The role of systemic inflammation in a prospective study

Objective: To investigate the association between the metabolically healthy obesity (MHO) phenotype and incident chronic kidney disease (CKD) in a Chinese population and whether systemic inflammation affects this association. Methods: A cohort study was performed with 2,491 Chinese adults. Body mass index ≥ 25.0 kg/m² was defined as obesity. CKD was defined as estimated glomerular filtration rate < 60 mL/min per 1.73 m² or urinary albumin-to-creatinine ratio ≥ 30 mg/g. High-sensitivity C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Results: Over a median follow-up period of 3.9 years, 243 of 2,491 participants developed incident CKD (9.8%). Compared with metabolically healthy nonobesity (MHNO), MHO was associated with incident CKD (odds ratio [OR] = 1.65, 95% confidence interval [CI] 1.01-2.69), but not after adjustment for hsCRP. The MHO/hsCRP ≥ 0.20 mg/L group, but not the MHO/hsCRP < 0.20 mg/L group, had an increased OR for incident CKD (OR = 2.66, 95% CI 1.37-5.14), with the MHNO/hsCRP < 0.20 mg/L group as the reference. Conclusions: MHO was significantly associated with incident CKD, and the level of systemic inflammation partially explained this association.