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

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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.

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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.

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Authors and Affiliations

  1. INSERM, CHU Nancy, Université de Lorraine, CIC-1433, Epidémiologie clinique, 54000, Nancy, France

    M. L. Schweitzer, K. Legrand & C. Ayav

  2. CESP Centre for Research in Epidemiology and population Health, UMRS 1018, University Paris-Saclay, University Paris Sud, UVSQ, 94807, Villejuif, France

    B. Stengel, C. Jacquelinet & Z. A. Massy

  3. Université de lorraine, 4360 APEMAC, 54000, Nancy, EA, France

    K. Legrand & S. Briançon

  4. Agence de la Biomédecine, Saint-Denis, France

    C. Jacquelinet

  5. Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    C. Combe

  6. Inserm, U1026, Université Bordeaux Segalen, Bordeaux, France

    C. Combe

  7. Nephrology Department, Centre Hospitalier Lyon-Sud, Univ Lyon, UCBL, Carmen, 69495, Pierre-Bénite, France

    D. Fouque & M. Laville

  8. Nephrology Department, CHU Ambroise Paré, Boulogne, France

    Z. A. Massy

  9. Nephrology Department, CHU Nancy, Vandoeuvre-lès-Nancy, France

    L. Frimat

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  1. M. L. Schweitzer
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Correspondence to C. Ayav.

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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).

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Schweitzer, M.L., Stengel, B., Legrand, K. et al. Obesity phenotype and patient-reported outcomes in moderate and severe chronic kidney disease: a cross-sectional study from the CKD-REIN cohort study. Qual Life Res 28, 1873–1883 (2019). https://doi.org/10.1007/s11136-019-02110-2

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