SAT-697 Baseline glucose profiles and weight trajectory influence renal function decline in obese individuals with diabetes

Abstract Disclosure: H. Kubo: None. A. Suzuki: None. M. Taneda: None. Y. Ko: None. Y. Yamasawa: None. M. Hitomi: None. T. Taguchi: None. A. Hayashi: None. R. Ichikawa: None. T. Miyatsuka: None. Objective: Obesity and diabetes have become global pandemics, increasing the risk of developing chronic kidney disease (CKD). Achieving weight loss in people with obesity can improve obesity-associated comorbidities, including CKD. Although recent advances in weight reduction, such as the use of glucagon-like peptide-1 receptor agonists and bariatric surgery, have shown nephroprotective effects in obese individuals, the impact of weight loss on the progressive decline in glomerular filtration rate (GFR) remains unclear in these populations. Hence, we evaluated the association between the slope of estimated GFR (eGFR), representing a parameter of renal function decline, and other clinical parameters over a period of 5 years or more in individuals with obesity and diabetes. Methods: A total of 434 subjects (165 males and 269 females) with diabetes and obesity (body mass index ≥ 30 kg/m2), who visited our hospital continuously and had eGFR data for 5 years or more between April 2006 to November 2024, were analyzed retrospectively. Annual eGFR data were collected every April ± 1 month, and the association between eGFR slope and percent total body weight loss (%TBWL), as well as other clinical parameters, was evaluated over the observation period. Results: The median [interquartile range: IQR] values of clinical parameters at the starting point of observation were as follows: age 44.0 [37.0, 56.0], BMI 35.8 [32.4, 38.7] kg/m2, %TBWL 2.2 [-8.1, 11.1] %, eGFR 81.7 [66.0, 98.9] mL/min/1.73m2, blood glucose level 125.0 [105.0, 178.0] mg/dL and HbA1c 6.5 [5.7, 8.4] %. The follow-up period was 12.0 [8.0, 15.0] years, and eGFR slope was -1.6 [-2.9, -0.5] mL/min/1.73m2/year. The eGFR slope was positively associated with %TBWL (P=0.025) and baseline serum chloride levels (P=0.029), and negatively associated with baseline blood glucose levels (P=0.0014) and HbA1c (P<0.001). Multiple linear regression analysis demonstrated that %TBWL (P=0.014) was positively correlated with eGFR slope, while baseline HbA1c (P=0.0048) was negatively correlated with it even after adjusting for covariates in the linear regression models. Conclusion: The long-term retrospective observation over 5 years or more demonstrated that poor glycemic control (HbA1c) at baseline and insufficient weight loss (decreased %TBWL) are associated with a rapid decline in eGFR, which indicates more progressive CKD. These data suggest that more careful and sustained management of body weight is necessary to improve renal outcomes in obese people with diabetes. Further adequately powered and longer-term data would provide additional information regarding the durability of this impact. Presentation: Saturday, July 12, 2025