Risk of Developing Chronic Kidney Disease among Obese Metabolically Free Adults: A Systematic Review/Meta-Analysis

Abstract Background Metabolically healthy obesity (MHO) is a type of obesity characterized by a favorable metabolic picture. Yet, the relationship between chronic kidney disease (CKD) and MHO has not been established. This review investigates the relationship between the metabolic healthy phenotype of obesity and the development or progression of CKD. Objective To determine the risk of development or progression of chronic kidney disease (eGFR <60 ml/min/1.73 m2) in metabolically healthy obese individuals. Methods A literature search was performed in 5 databases using the following search strategies: (” chronic kidney disease” OR “end-stage renal disease” OR “estimated glomerular filtration rate” OR “kidney function”) AND (“obesity” OR “metabolic syndrome” OR “metabolically healthy” OR “metabolically healthy obesity” OR “overweight” OR “metabolically healthy overweight “OR “metabolic parameters” OR “metabolic profile” OR “obesity without metabolic abnormality” OR “healthy obesity”). We included prospective, retrospective cohort studies and case-control studies in English, French, Spanish, and Arabic until December 2022 that investigated the development or progression of CKD in adults > 18 years with a baseline GFR of ≥ 60 ml/min/1.73 m2 exposed to MHO. A total of 12579 studies were retrieved, and 12564 were excluded due to different populations, exposures, or outcomes. Studies with missing data, narrative reviews, systematic reviews, meta-analyses, case reports, case series, and commentaries, along with studies conducted on animals, were also excluded. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting. Results We included 15 cohort studies with 5,039,394 participants. MHO subjects showed an increased risk for CKD with a pooled risk ratio (RR) of 1.42, 95% CI (1.25–1.61), p < 0.001 using the random effects model. Heterogeneity is high, as indicated by Cochrane Q = 73.35 and I squared (I2) = 81%. Conclusion Metabolic healthy obese adults have a significantly higher risk of the development or progression of CKD.