High adolescent BMI increases risk of early chronic kidney disease, according to JAMA study by Hebrew University researchers

New study finds that adolescent obesity significantly heightens the risk of developing early chronic kidney disease in young adulthood. Even those with high-normal BMI are at risk. Severe obesity poses the highest risk, but even mild obesity and being overweight contribute significantly to this increased risk for both males and females. Lowering obesity rates in adolescents is crucial to better managing the risk of kidney disease and subsequent cardiovascular issues. This study emphasizes the need for preventive measures and management of risk factors associated with chronic kidney disease in adolescents with elevated BMI.

JERUSALEM -- Adolescent obesity significantly increases the risk of developing early chronic kidney disease (CKD) in young adulthood, according to a large cohort study led by Hebrew University of Jerusalem (HU) and Sheba Tel HaShomer Medical Center researchers.

The new study, published in the prestigious JAMA Pediatrics, highlights the importance of lowering adolescent obesity rates to better manage the risk of kidney disease for adolescents with high body mass index (BMI). While those with severe obesity appear more at risk, researchers also found cause for concern for seemingly healthy individuals with high-normal BMI under 30.

Despite increasing obesity rates in adolescents, data indicating a link to the onset of early chronic kidney disease had been lacking, reports the research team led by Avishai M. Tsur, M.D., of the Hebrew University Department of Military Medicine, Faculty of Medicine, and a resident at Sheba Tel HaShomer Medical Center. "These findings are a harbinger of the potentially preventable, increasing likelihood of developing chronic kidney disease and subsequent cardiovascular disease,” the researchers say.

The study, conducted by colleagues from major health institutions in Israel and the United States, including Johns Hopkins and Harvard University, included data on 593,660 Israeli adolescents ages 16-20, born after January 1, 1975, who had medical assessments for mandatory military service.

With a mean follow-up of 13.4 years, 1,963 adolescents (0.3%) overall developed early chronic kidney disease:

• For males, the risk of developing CKD increased the most with severe obesity (hazard ratio [HR], 9.4). It was also detected with mild obesity (HR, 6.7), and in those who were overweight (HR, 4.0), or had a high-normal BMI in adolescence (HR, 1.8).

• Among females, increased risk was greatest with severe obesity (HR, 4.3). It was also linked to those who had mild obesity (HR, 2.7), were overweight (HR, 2.3), or had high-normal BMI (HR 1.4).

The findings of this cohort study underscore the importance of mitigating adolescent obesity rates and managing the risk factors associated with developing CKD.

Researchers

Avishai M Tsur ^1,2,3,4, Inbal Akavian ^1,2, Regev Landau ^1,2,3,4, Estela Derazne ⁴, Dorit Tzur ¹, Asaf Vivante ^4,5, Ehud Grossman ^3,4, Ran S Rotem ^6,7, Boris Fishman ^4,8, Orit Pinhas-Hamiel ^4,9, Arnon Afek ¹⁰, Josef Coresh ¹¹, Gabriel Chodick ^4,6, Gilad Twig ^1,2,12,13,14

Institutions

¹Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.

²Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.

³Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel.

⁴Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

⁵Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.

⁶Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.

⁷Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

⁸Division of Cardiology, Sheba Medical Center, Tel HaShomer, Israel.

⁹Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.

¹⁰Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

¹¹Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

¹²Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

¹³Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

¹⁴The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.