Advertisement

Obesity phenotype and patient-reported outcomes in moderate and severe chronic kidney disease: a cross-sectional study from the CKD-REIN cohort study

  • M. L. Schweitzer
  • B. Stengel
  • K. Legrand
  • S. Briançon
  • C. Jacquelinet
  • C. Combe
  • D. Fouque
  • Z. A. Massy
  • M. Laville
  • L. Frimat
  • C. AyavEmail author
Article

Abstract

Purpose

To evaluate the association between obesity phenotypes and health-related quality of life (HRQoL) in non-dialysis-dependent CKD patients.

Methods

Data from the national CKD-REIN cohort which included 3033 patients with stage 3–4 CKD were used. Patients were divided into three groups: non-obese (NO) patients (BMI < 30 kg/m2), metabolically healthy obese (MHO) (BMI ≥ 30 kg/m2 and ≤ 1 criterion NCEP/ATP III), and metabolically unhealthy obese (MUO) (BMI ≥ 30 kg/m2 and ≥ 2 criteria NCEP/ATP III). HRQoL was measured by the KDQOL-36™ which comprised three disease-specific dimensions: symptoms, effects, and burden and two summaries scores: physical (PCS) and mental (MCS). We used a mixed effect model with adjustment on sociodemographic characteristics and comorbidities.

Results

A total of 2693 patients completed the self-administered questionnaires. MHO patients accounted for 3.4% of the cohort and for 12% of obese patients. In the NO group, average HRQoL scores were 77.2 ± 15.9 for symptoms, 83.5 ± 16.5 for effects, 76.8 ± 22.7 for burden, 43.5 ± 9.7 for PCS, and 47.9 ± 7.0 for MCS. In the multivariate analysis, scores were similar in MHO and NO patients, but significantly different with those in MUO patients: symptoms (− 0.7; p = 0.71 vs. − 3.0; p = 0.0025), effects (+ 1.2; p = 0.57 vs. − 4.3; p < 0.0001), burden (+ 2.7; p = 0.31 vs. − 3.6; p = 0.0031), and PCS (− 0.6; p = 0.58 vs. − 4.3; p < 0.0001). MCS was not associated with obesity phenotypes.

Conclusions

This study demonstrated an association between obesity phenotypes and QoL in non-dialysis-dependent CKD patients. MUO patients had worse QoL than NO and MHO patients even after adjustment on comorbidities.

Keywords

Chronic kidney disease Patient-reported outcomes Quality of life Obesity Metabolically healthy obesity 

Notes

Acknowledgements

We acknowledge the CKD-REIN study coordination staff for their efforts in setting up the CKD-REIN cohort: Marie Metzger, Elodie Speyer, Céline Lange, Sophie Renault, Reine Ketchemin, and all the clinical research associates. We thank Brigitte Bourdillat for editing the English version. The CKD-REIN Study Group: Steering committee and coordination: Carole Ayav, Serge Briançon, Dorothée Cannet, Christian Combe, Denis Fouque, Luc Frimat, Yves-Edouard Herpe, Christian Jacquelinet, Maurice Laville, Ziad A Massy, Christophe Pascal, Bruce M Robinson, Bénédicte Stengel, Céline Lange, Karine Legrand, Sophie Liabeuf, Marie Metzger, Elodie Speyer. CKD-REIN collaborators: Thierry Hannedouche, Bruno Moulin, Sébastien Mailliez, Gaétan Lebrun, Eric Magnant, Gabriel Choukroun, Benjamin Deroure, Adeline Lacraz, Guy Lambrey, Jean Philippe Bourdenx, Marie Essig, Thierry Lobbedez, Raymond Azar, Hacène Sekhri, Mustafa Smati, Mohamed Jamali, Alexandre Klein, Michel Delahousse, Christian Combe, Séverine Martin, Isabelle Landru, Eric Thervet, Ziad A Massy, Philippe Lang, Xavier Belenfant, Pablo Urena, Carlos Vela, Luc Frimat, Dominique Chauveau, Viktor Panescu, Christian Noel, François Glowacki, Maxime Hoffmann, Maryvonne Hourmant, Dominique Besnier, Angelo Testa, François Kuentz, Philippe Zaoui, Charles Chazot, Laurent Juillard, Stéphane Burtey, Adrien Keller, Nassim Kamar, Denis Fouque, Maurice Laville.

Funding

CKD-REIN is funded by the Agence Nationale de la Recherche through the 2010 «Cohortes-Investissements d’Avenir » program and by the 2010 national Programme Hospitalier de Recherche Clinique. CKD-REIN is also supported through a public–private partnership with Amgen, Fresenius Medical Care, GlaxoSmithKline (GSK), since 2012, Lilly France since 2013, and Otsuka Pharmaceutical since 2015, Baxter and Merck Sharp & Dohme-Chibret (MSD France) from 2012 to 2017, Sanofi-Genzyme from 2012 to 2015, and Vifor Fresenius, since 2018. Inserm Transfert set up and has managed this partnership since 2011.

Compliance with ethical standards

Conflict of interest

CKD-REIN is supported by a public–private partnership with funding from 9 pharmaceutical companies as listed above. All authors declare that they have no relevant financial interests.

Ethics approval

All legal authorizations were obtained including those from the Comité consultatif sur le traitement de l’information en matière de recherche dans le domaine de la santé (CCTIRS No 12.360), the Commission nationale de l’informatique et des libertés (CNIL No DR-2012-469), and the Comité de protection des personnes IDF VII (CPP No IDRCB 2012-A00902-41). CKD-REIN biological collection is registered in the management application of the COnservation D’Eléments du COrps Humain (CODECOCH No-2012-1624). The Institut national de la santé et de la recherche médicale (Inserm) Institutional Review Board approved the study protocol (IRB00003888).

References

  1. 1.
    Mills, K. T., Xu, Y., Zhang, W., Bundy, J. D., Chen, C.-S., Kelly, T. N., et al. (2015). A systematic analysis of world-wide population-based data on the global burden of chronic kidney disease in 2010. Kidney International, 88(5), 950–957.  https://doi.org/10.1038/ki.2015.230.CrossRefGoogle Scholar
  2. 2.
    Brück, K., Stel, V. S., Gambaro, G., Hallan, S., Völzke, H., Ärnlöv, J., et al. (2016). CKD prevalence varies across the European General Population. Journal of the American Society of Nephrology, 27(7), 2135–2147.  https://doi.org/10.1681/ASN.2015050542.CrossRefGoogle Scholar
  3. 3.
    Haute Autorité de Santé. (2012). Guide du parcours de soins: Maladie Rénale Chronique. Ressource document. https://www.has-sante.fr/portail/upload/docs/application/pdf/2012-04/guide_parcours_de_soins_mrc_web.pdf. Accessed 07 May 2018.
  4. 4.
    Kimmel, P. L., & Peterson, R. A. (2005). Psychosocial factors in patients with chronic kidney disease: Depression in end-stage renal disease patients treated with hemodialysis: Tools, correlates, outcomes, and needs. Seminars in Dialysis, 18(2), 91–97.  https://doi.org/10.1111/j.1525-139X.2005.18209.x.CrossRefGoogle Scholar
  5. 5.
    Elder, S. J., Pisoni, R. L., Akizawa, T., Fissell, R., Andreucci, V. E., Fukuhara, S., et al. (2008). Sleep quality predicts quality of life and mortality risk in haemodialysis patients: Results from the dialysis outcomes and practice patterns study (DOPPS). Nephrology, Dialysis, Transplantation, 23(3), 998–1004.  https://doi.org/10.1093/ndt/gfm630.CrossRefGoogle Scholar
  6. 6.
    Lopes, A. A., Albert, J. M., Young, E. W., Satayathum, S., Pisoni, R. L., Andreucci, V. E., et al. (2004). Screening for depression in hemodialysis patients: Associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney International, 66(5), 2047–2053.  https://doi.org/10.1111/j.1523-1755.2004.00977.x.CrossRefGoogle Scholar
  7. 7.
    Perlman, R. L., Finkelstein, F. O., Liu, L., Roys, E., Kiser, M., Eisele, G., et al. (2005). Quality of life in chronic kidney disease (CKD): A cross-sectional analysis in the Renal Research Institute-CKD study. American Journal of Kidney Diseases, 45(4), 658–666.CrossRefGoogle Scholar
  8. 8.
    Mapes, D. L., Lopes, A. A., Satayathum, S., Mccullough, K. P., Goodkin, D. A., Locatelli, F., et al. (2003). Health-related quality of life as a predictor of mortality and hospitalization: The dialysis outcomes and practice patterns study (DOPPS). Kidney International, 64(1), 339–349.  https://doi.org/10.1046/j.1523-1755.2003.00072.x.CrossRefGoogle Scholar
  9. 9.
    Hall, R. K., Luciano, A., Pieper, C., & Colón-Emeric, C. S. (2018). Association of kidney, disease quality of life (KDQOL-36) with mortality and hospitalization in older adults receiving hemodialysis. BMC Nephrology, 19(1), 11.  https://doi.org/10.1186/s12882-017-0801-5.CrossRefGoogle Scholar
  10. 10.
    Lowrie, E. G., Curtin, R. B., LePain, N., & Schatell, D. (2003). Medical outcomes study short form-36: A consistent and powerful predictor of morbidity and mortality in dialysis patients. American Journal of Kidney Diseases, 41(6), 1286–1292.  https://doi.org/10.1016/S0272-6386(03)00361-5.CrossRefGoogle Scholar
  11. 11.
    Porter, A. C., Lash, J. P., Xie, D., Pan, Q., DeLuca, J., Kanthety, R., et al. (2016). Predictors and outcomes of health-related quality of life in adults with CKD. Clinical Journal of the American Society of Nephrology, 11(7), 1154–1162.  https://doi.org/10.2215/CJN.09990915.CrossRefGoogle Scholar
  12. 12.
    Finkelstein, F. O., Wuerth, D., & Finkelstein, S. H. (2009). Health related quality of life and the CKD patient: challenges for the nephrology community. Kidney International, 76(9), 946–952.  https://doi.org/10.1038/ki.2009.307.CrossRefGoogle Scholar
  13. 13.
    Boiteux, G., Hannedouche, T., Siebert, M., & Lassalle, M. in name of registre du REIN. (2015) Chapitre 3-Caractéristiques initiales et indicateurs de prise en charge des nouveaux malades dialysés - Initial clinical caracteristics and care indicators for new dialysis patients. Ressource document. Agence de Biomédecine. https://www.agence-biomedecine.fr/IMG/pdf/rapport_rein_2015.pdf. Accessed 07 May 2018.
  14. 14.
    Matta, J., Zins, M., Feral-Pierssens, A. L., Carette, C., Ozguler, A., Goldberg, M., et al. (2016). Prévalence du surpoids, de l’obésité et des facteurs de risque cardio-métaboliques dans la cohorte Constances. Bulletin Epidémiologique Hebdomadaire, (35–36):640–646. http://invs.santepubliquefrance.fr/beh/2016/35-36/2016_35-36_5.html. Accessed 07 May 2018.
  15. 15.
    Pagels, A. A., Söderkvist, B. K., Medin, C., Hylander, B., & Heiwe, S. (2012). Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment. Health and Quality of Life Outcomes, 10, 71.  https://doi.org/10.1186/1477-7525-10-71.CrossRefGoogle Scholar
  16. 16.
    Brønnum-Hansen, H., Juel, K., Davidsen, M., & Sørensen, J. (2007). Impact of selected risk factors on quality-adjusted life expectancy in Denmark. Scandinavian Journal of Public Health, 35(5), 510–515.  https://doi.org/10.1080/14034940701271908.CrossRefGoogle Scholar
  17. 17.
    Zimbudzi, E., Lo, C., Ranasinha, S., Gallagher, M., Fulcher, G., Kerr, P. G., et al (2016). Predictors of health-related quality of life in patients with co-morbid diabetes and chronic kidney disease. PLoS ONE, 11(12), e0168491.  https://doi.org/10.1371/journal.pone.0168491.CrossRefGoogle Scholar
  18. 18.
    Sims, E. A. (2001). Are there persons who are obese, but metabolically healthy? Metabolism: Clinical and Experimental, 50(12), 1499–1504.  https://doi.org/10.1053/meta.2001.27213.CrossRefGoogle Scholar
  19. 19.
    Karelis, A. D., Brochu, M., & Rabasa-Lhoret, R. (2004). Can we identify metabolically healthy but obese individuals (MHO)? Diabetes and Metabolism, 30, 569–572.CrossRefGoogle Scholar
  20. 20.
    Karelis, A. D. (2008). Metabolically healthy but obese individuals. The Lancet, 372(9646), 1281–1283.  https://doi.org/10.1016/S0140-6736(08)61531-7.CrossRefGoogle Scholar
  21. 21.
    Phillips, C. M. (2013). Metabolically healthy obesity: Definitions, determinants and clinical implications. Reviews in Endocrine & Metabolic Disorders, 14(3), 219–227.  https://doi.org/10.1007/s11154-013-9252-x.CrossRefGoogle Scholar
  22. 22.
    Bell, J. A., Kivimaki, M., & Hamer, M. (2014). Metabolically healthy obesity and risk of incident type 2 diabetes: A meta-analysis of prospective cohort studies. Obesity Reviews, 15(6), 504–515.  https://doi.org/10.1111/obr.12157.CrossRefGoogle Scholar
  23. 23.
    Hinnouho, G.-M., Czernichow, S., Dugravot, A., Nabi, H., Brunner, E. J., Kivimaki, M., & Singh-Manoux, A. (2015). Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: The Whitehall II cohort study. European Heart Journal, 36(9), 551–559.  https://doi.org/10.1093/eurheartj/ehu123.CrossRefGoogle Scholar
  24. 24.
    Meigs, J. B., Wilson, P. W. F., Fox, C. S., Vasan, R. S., Nathan, D. M., Sullivan, L. M., & D’Agostino, R. B. (2006). Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. The Journal of Clinical Endocrinology and Metabolism, 91(8), 2906–2912.  https://doi.org/10.1210/jc.2006-0594.CrossRefGoogle Scholar
  25. 25.
    Appleton, S. L., Seaborn, C. J., Visvanathan, R., Hill, C. L., Gill, T. K., Taylor, A. W., et al. (2013). Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: A cohort study. Diabetes Care, 36(8), 2388–2394.  https://doi.org/10.2337/dc12-1971.CrossRefGoogle Scholar
  26. 26.
    Stengel, B., Combe, C., Jacquelinet, C., Briançon, S., Fouque, D., Laville, M., et al. (2014). The french chronic kidney disease-renal epidemiology and information network (CKD-REIN) cohort study. Nephrology, Dialysis, Transplantation, 29(8), 1500–1507.  https://doi.org/10.1093/ndt/gft388.CrossRefGoogle Scholar
  27. 27.
    Stengel, B., Metzger, M., Combe, C., Jacquelinet, C., Briançon, S., Ayav, C., et al. (2018). Risk profile, quality of life and care of patients with moderate and advanced CKD: The French CKD-REIN Cohort Study. Nephrology, Dialysis, Transplantation.  https://doi.org/10.1093/ndt/gfy058 (Epub ahead of print).Google Scholar
  28. 28.
    Hays, R. D., Kallich, J. D., Mapes, D. L., Coons, S. J., & Carter, W. B. (1994). Development of the kidney disease quality of life (KDQOL) instrument. Quality of Life Research, 3(5), 329–338.CrossRefGoogle Scholar
  29. 29.
    Boini, S., Leplege, A., Loos Ayav, C., Français, P., Ecosse, E., & Briançon, S. (2007). Measuring quality of life in end-stage renal disease. Transcultural adaptation and validation of the specific kidney disease quality of life questionnaire. Nephrologie & Therapeutique, 3(6), 372–383.  https://doi.org/10.1016/j.nephro.2007.05.005.CrossRefGoogle Scholar
  30. 30.
    Hays, R. D. (1997). Kidney disease quality of life short form (KDQOL SF), version 1.3: A manual for use and scoring. RAND. Ressource document. https://www.rand.org/content/dam/rand/pubs/papers/2006/P7994.pdf. Accessed 20 Dec 2017.
  31. 31.
    Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10(2), 77–84.CrossRefGoogle Scholar
  32. 32.
    Fuhrer, R., Rouillon, F., & Institut National de la Santé et de la Recherche Médicale. (I.N.S.E.R.M.). (1989). La version française de l’échelle CES-D (Center for Epidemiologic Studies-Depression Scale). Psychiatrie et Psychobiologie, 4, 163–166.Google Scholar
  33. 33.
    Levey, A. S., de Jong, P. E., Coresh, J., Nahas, M. E. l., Astor, B. C., Matsushita, K., et al. (2011). The definition, classification, and prognosis of chronic kidney disease: A KDIGO controversies conference report. Kidney International, 80(1), 17–28.  https://doi.org/10.1038/ki.2010.483.CrossRefGoogle Scholar
  34. 34.
    Insee. (2018). Revenu disponible correspondant au seuil de pauvreté selon le type de ménage en 2016. Ressource document. https://www.insee.fr/fr/statistiques/3564668#tableau-Donnes. Accessed 15 Feb 2018.
  35. 35.
    Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology, 58(6), 595–602.  https://doi.org/10.1016/j.jclinepi.2004.10.018.CrossRefGoogle Scholar
  36. 36.
    Hayes, L., Pearce, M. S., Firbank, M. J., Walker, M., Taylor, R., & Unwin, N. C. (2010). Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study. BMC Public Health, 10, 723.  https://doi.org/10.1186/1471-2458-10-723.CrossRefGoogle Scholar
  37. 37.
    Cadenas-Sanchez, C., Ruiz, J. R., Labayen, I., Huybrechts, I., Manios, Y., González-Gross, M., et al. (2017). Prevalence of metabolically healthy but overweight/obese phenotype and its association with sedentary time, physical activity, and fitness. Journal of Adolescent Health, 61(1), 107–114.  https://doi.org/10.1016/j.jadohealth.2017.01.018.CrossRefGoogle Scholar
  38. 38.
    Loos-Ayav, C., Frimat, L., Kessler, M., Chanliau, J., Durand, P.-Y., & Briançon, S. (2008). Changes in health-related quality of life in patients of self-care vs. in-center dialysis during the first year. Quality of Life Research, 17(1), 1–9.  https://doi.org/10.1007/s11136-007-9286-1.CrossRefGoogle Scholar
  39. 39.
    Mapes, D. L., Bragg-Gresham, J. L., Bommer, J., Fukuhara, S., McKevitt, P., Wikström, B., & Lopes, A. A. (2004). Health-related quality of life in the dialysis outcomes and practice patterns study (DOPPS). American Journal of Kidney Diseases, 44(5 Suppl 2), 54–60.CrossRefGoogle Scholar
  40. 40.
    Ricardo, A. C., Hacker, E., Lora, C. M., Ackerson, L., DeSalvo, K. B., Go, A., et al. (2013). Validation of the kidney disease quality of life short form 36 (KDQOL-36™) US Spanish and English versions in a cohort of hispanics with chronic kidney disease. Ethnicity & Disease, 23(2), 202–209.Google Scholar
  41. 41.
    Fukuhara, S., Lopes, A. A., Bragg-Gresham, J. L., Kurokawa, K., Mapes, D. L., Akizawa, T., et al (2003). Health-related quality of life among dialysis patients on three continents: The dialysis outcomes and practice patterns study. Kidney International, 64(5), 1903–1910.  https://doi.org/10.1046/j.1523-1755.2003.00289.x.CrossRefGoogle Scholar
  42. 42.
    Mujais, S. K., Story, K., Brouillette, J., Takano, T., Soroka, S., Franek, C., et al. (2009). Health-related quality of life in CKD patients: Correlates and evolution over time. Clinical Journal of the American Society of Nephrology, 4(8), 1293–1301.  https://doi.org/10.2215/CJN.05541008.CrossRefGoogle Scholar
  43. 43.
    Lopes, A. A., Bragg-Gresham, J. L., Satayathum, S., McCullough, K., Pifer, T., Goodkin, D. A., et al. (2003). Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: The dialysis outcomes and practice patterns study (DOPPS). American Journal of Kidney Diseases, 41(3), 605–615.  https://doi.org/10.1053/ajkd.2003.50122.CrossRefGoogle Scholar
  44. 44.
    Lopez-Garcia, E., Guallar-Castillón, P., Garcia-Esquinas, E., & Rodríguez-Artalejo, F. (2017). Metabolically healthy obesity and health-related quality of life: A prospective cohort study. Clinical Nutrition, 36(3), 853–860.  https://doi.org/10.1016/j.clnu.2016.04.028.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • M. L. Schweitzer
    • 1
  • B. Stengel
    • 2
  • K. Legrand
    • 1
    • 3
  • S. Briançon
    • 3
  • C. Jacquelinet
    • 2
    • 4
  • C. Combe
    • 5
    • 6
  • D. Fouque
    • 7
  • Z. A. Massy
    • 2
    • 8
  • M. Laville
    • 7
  • L. Frimat
    • 9
  • C. Ayav
    • 1
    Email author
  1. 1.INSERM, CHU NancyUniversité de LorraineNancyFrance
  2. 2.CESP Centre for Research in Epidemiology and population Health, UMRS 1018University Paris-Saclay, University Paris Sud, UVSQVillejuifFrance
  3. 3.Université de lorraineNancyFrance
  4. 4.Agence de la BiomédecineSaint-DenisFrance
  5. 5.Service de Néphrologie Transplantation Dialyse AphérèseCentre Hospitalier Universitaire de BordeauxBordeauxFrance
  6. 6.Inserm, U1026Université Bordeaux SegalenBordeauxFrance
  7. 7.Nephrology DepartmentCentre Hospitalier Lyon-Sud, Univ Lyon, UCBLPierre-BéniteFrance
  8. 8.Nephrology DepartmentCHU Ambroise ParéBoulogneFrance
  9. 9.Nephrology DepartmentCHU NancyVandoeuvre-lès-NancyFrance

Personalised recommendations