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논문분류	춘계학술대회 초록집
제목	Association of Time-Updated Body Mass Index With the Initiation of Kidney Replacement Therapy in Patients With Chronic Kidney Disease: Results from the KNOW-CKD Study
저자	Minsang Kim
출판정보	2025; 2025(1):
키워드	Chronic kidney disease, Body mass index, Kidney replacement therapy, Marginal structural Cox model
초록	The association between body mass index (BMI) and the risk of kidney replacement therapy (KRT) initiation in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) remains uncertain. Given the controversies around using baseline BMI as the only exposure in analysis, we aimed to investigate the association between time-updated BMI and the risk of KRT initiation in NDD-CKD patients, employing a marginal structural Cox model (Cox-MSM). A total of 2136 patients enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD were included in this study. The exposure was baseline and time-updated BMI. The outcome was the initiation of KRT including dialysis or kidney transplantation during follow-up period. A multivariable Cox proportional hazards (Cox-PH) model, a time-dependent Cox model without inverse probability weights, and a Cox-MSM were fitted, adjusting for both time-fixed covariates, including age, sex, smoking, and comorbidities, and time-varying covariates including estimated glomerular filtration rate, hemoglobin, and systolic blood pressure During the median follow-up of 8.3 years, the KRT initiation occurred in 723 patients (34%). In patients with a BMI ≥25kg/m2, a higher time-updated BMI was significantly associated with a lower risk of KRT initiation compared to the reference group with BMI 23–24.9 kg/m2 and a gradual decrease in the risk of KRT initiation with increasing BMI was observed. The groups with BMI 25–27.4 kg/m2 (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.64–1.00), BMI 27.5–29.9 kg/m2 (HR, 0.76; 95% CI, 0.59–0.98), and BMI ≥30 kg/m2 (HR, 0.75; 95% CI, 0.58–0.97) exhibited a significantly lower risk of KRT initiation. A higher time-updated BMI has a lower risk of KRT initiation in obese patients with NDD-CKD in Korea. Therefore, clinicians should carefully monitor the weight fluctuations and maintain appropriate weight range through regular weight measurements.
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