title: Combined effect of body mass index and metabolic status on the risk of prevalent and incident chronic kidney disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The risk of chronic kidney disease (CKD) differs in the normal weight, overweight, and obese individuals owing to metabolic abnormality. We aimed to determine the combined effects of body mass index (BMI) and metabolic status on the risk of the prevalence and incidence of CKD.
  
  
  METHODS
  Pubmed, Scopus, Web of science, and abstracts from recently relevant meetings prior to April 2016 were searched to identify eligible studies. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using a random effects model.
  
  
  RESULTS
  Eight cross-sectional studies and four longitudinal follow-up studies with a total of 14787 and 166718 participants were separately included in present study. Compared with metabolically healthy normal weight individuals, metabolically healthy obese individuals showed increased risk for CKD, with RR of 1.235 (95%CI: 1.027 to 1.484), while metabolically health overweight individuals still presented in a healthy pattern, RR=1.094(95%CI: 0.774 to 1.547). In addition, metabolically abnormal groups had much higher risk for CKD, with RR of 1.572 (95%CI: 1.373 to 1.801), 1.652(95%CI: 1.139 to 2.397) and 1.898(95%CI: 1.505 to 2.395) across metabolically unhealthy normal weight, overweight and obese individuals respectively.
  
  
  CONCLUSIONS
  Individuals with abnormal metabolic status are at a significantly elevated risk for CKD, regardless of BMI. For metabolically healthy individuals, CKD risk increases with the growth of BMI, and obese persons eventually have a higher risk.
authors: Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Zhejiang Province, P.R.China.
authors: Jian
authors: J
authors: Zhang
authors: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R.China.|Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration Of Traditional Chinese Medicine of PR China, P.R.China.|Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Zhejiang Province, P.R.China.
authors: Hong
authors: H
authors: Jiang
authors: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R.China.|Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration Of Traditional Chinese Medicine of PR China, P.R.China.|Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Zhejiang Province, P.R.China.
authors: Jianghua
authors: J
authors: Chen
mesh_terms: D015992:Body Mass Index; D004734:Energy Metabolism; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000150:complications / Q000378:metabolism; D015995:Prevalence; D017594:Publication Bias; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology*; D012306:Risk
keywords: body mass index; chronic kidney disease; meta-analysis; metabolic status; obesity