Association of body weight change with incident chronic kidney disease in patients with type 2 diabetes without proteinuria: a nationwide cohort study

Abstract The association of body weight change with chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is unclear. In this nationwide, Korean population-based cohort study, we investigated the association between body weight change and CKD in patients with T2DM using data from the Korean National Health Insurance Service (NHIS). Between January 2009 and December 2012, we analyzed data from 981,953 patients with T2DM without proteinuria who underwent two consecutive general health checkups. The mean interval between the two examinations was 715 ± 115 days. Body weight change was categorized as severe (≤ − 10%) and moderate (− 10% to ≤ − 5%) weight loss, stable weight (− 5% to ≤ 5%), and moderate (5% to ≤ 10%) and severe (> 10%) weight gain; during follow-up, the percentage of participants who developed incident CKD in these groups was 8.78%, 7.58%, 7.18%, 8.17%, and 9.26%, respectively. In a multivariate analysis using the stable weight group as reference, odds ratios (95% confidence interval) for CKD were 1.020 (0.972–1.070), 0.971 (0.948–0.995), 1.209 (1.179–1.241), and 1.528 (1.459–1.601) in the severe weight loss, moderate weight loss, moderate weight gain, and severe weight gain groups. Thus, in this nationwide Korean cohort of adults with T2DM without proteinuria, weight gain > 5% was consistently associated with higher odds of incident CKD, whereas moderate weight loss was associated with slightly lower odds. Severe weight loss showed higher crude CKD incidence but no independent association after multivariable adjustment, suggesting that marked weight loss should be interpreted cautiously.