• Hiroaki Kikuchi, Eiichiro Kanda, Shintaro Mandai, Masanobu Akazawa, Soichiro Iimori, Katsuyuki Oi, Shotaro Naito, Yumi Noda, Takayuki Toda, Teiichi Tamura, Sei Sasaki, Eisei Sohara, Tomokazu Okado, Tatemitsu Rai, and Shinichi Uchida.
• Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
• Clin. Exp. Nephrol. 2017 Feb 1; 21 (1): 55-62.

BackgroundThe relationship between protein-energy wasting and chronic kidney disease (CKD) progression is unknown. In the present prospective cohort study, we evaluated the hypothesis that a combination of low body mass index (BMI) and serum albumin level is associated with rapid CKD progression.MethodsThe study cohort comprised 728 predialysis Japanese patients with CKD (stages 2-5) enrolled from 2010 to 2011. Patients were categorized into four groups according to their serum albumin levels and BMI: group 1, low serum albumin level (<4 g/dL) and low BMI (<23.5 kg/m2); group 2, high serum albumin level (≥4 g/dL) and low BMI; group 3, low serum albumin level and high BMI (≥23.5 kg/m2); and group 4, high serum albumin level and high BMI. The primary outcome was a 30 % decline in estimated glomerular filtration rate (eGFR) or start of dialysis within 2 years. The secondary outcome was an annual GFR decline (mL/min/1.73 m2/year).ResultsLogistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that only group 1 was associated with a significant risk of CKD progression, with adjusted odds ratio of 3.51 [95 % confidence interval (CI) (1.63, 7.56)]. A multivariate linear regression analysis adjusted for baseline characteristics showed a significant difference in annual eGFR decline between groups 1 and 4 [coefficients β (standard error) -2.62 (0.75), p = 0.001].ConclusionThis study suggests that combined effects of low BMI (<23.5 kg/m2) and serum albumin level (<4 g/dL) are associated with CKD progression.

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