ADOLESCENT OBESITY, HYPERTENSION AND THE RISK FOR CHRONIC KIDNEY DISEASE

Objective: Adolescent obesity and hypertension are prevalent global health challenges with strong associations with chronic kidney disease. Despite their significant overlap, current clinical guidelines fail to address the compounded risk posed by these conditions. Our study objective is to estimate the individual and combined association of adolescent obesity and hypertension on the risk for chronic kidney disease in young adulthood. Design and method: In a nationwide cohort study, we included 629,168 adolescents aged 16-19 who underwent pre-military medical examination. We excluded 25,067 adolescents with preexisting kidney disease, missing weight or height measurements. Individuals were categorized based on obesity status and hypertension diagnosis (based on preexisting diagnosis or a workup process following a BP level of 140/90 mm Hg or above in screening). The outcome was chronic kidney disease and was defined as albuminuria of 30 mg/g or above with or without reduced glomerular filtration rate. Cox proportional hazards models were used to estimate the association between these risk factors and chronic kidney disease development. Results: Among 604,101 eligible adolescents (54.6% males), 3,930 (0.6%) developed chronic kidney disease during a median follow-up time of 13.82 years. Mean age at chronic kidney disease diagnosis was 31.6 years. Adjusted hazard ratios for chronic kidney disease among those with hypertension only, obesity only, and hypertension and obesity were 2.88 (1.75–4.68), 2.15 (1.99-2.31), and 5.29 (3.64-7.69), respectively. These associations remained robust across sensitivity analyses, including chronic kidney disease onset before age 40. Stratification by chronic kidney disease stage at diagnosis revealed the highest risk for isolated proteinuria across all groups. Conclusions: This study found that adolescents with both obesity and hypertension are at an increased risk for chronic kidney disease than adolescents with either condition alone or neither. These findings emphasize the importance of addressing combined cardiometabolic risk factors during adolescence to mitigate long-term kidney disease burden.