Combined effects of glycemic status and adiposity on cardiovascular risk in chronic kidney disease: A nationwide population-based study

BACKGROUND Obesity and diabetes are well-established risk factors for cardiovascular disease (CVD), and their coexistence is particularly detrimental in chronic kidney disease (CKD). However, the interactions between various adiposity patterns and glycemic status in influencing CVD outcomes in CKD remain inadequately defined. AIM To evaluate the combined effects of diabetes, body mass index (BMI), and waist circumference (WC) on CVD risk. METHODS We analyzed data from 1714859 adults with CKD sourced from the Korean National Health Insurance database. Participants were classified into three glycemic groups: Normoglycemia, impaired fasting glucose (IFG), and diabetes mellitus (DM). BMI and WC were further categorized into five and six levels, respectively. Incident CVD events and all-cause mortality were assessed across the combined categories of glycemic status and adiposity. Incidence rates and adjusted hazard ratios were computed using Cox proportional hazards models. RESULTS A significant interaction was identified between glycemic status and adiposity indices concerning CVD risk (P for interaction < 0.001). Among normoglycemic individuals, both underweight (BMI < 18.5 kg/m2) and central obesity (WC ≥ 100/95 cm in men/women) were associated with increased CVD risk and mortality. In individuals with IFG, underweight remained a consistent risk factor, while WC displayed a linear relationship with CVD but not with mortality. In those with DM, the highest CVD risk was observed in individuals who were underweight (BMI < 18.5 kg/m2) and had low WC (< 80 cm in men/< 75 cm in women). CONCLUSION Cardiovascular risk is jointly influenced by glycemic status and adiposity, with diabetes consistently elevating risk across all BMI and WC categories, underscoring the importance of their assessment in CKD.