Skip to content
DraconiticResearch
Search Sources API
203,203 studies31 sourcesUpdated 7 min ago
Peer-reviewedCC BY-NC-NDKidney medicine

The Obesity Paradox in Chronic Kidney Disease: Cardiorespiratory Fitness Is Associated With Mortality Independent of Body Mass Index.

  • Swathi Balantrapu1
  • Peter Kokkinos2,3
  • Immanuel B H Samuel4,5
  • Andreas Pittaras2
  • Charles Faselis6
  • Jonathan Myers7
7 affiliations
  1. 1Geriatric Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
  2. 2Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ.
  3. 3Cardiology Department, Veterans Affairs Medical Center, Washington, DC.
  4. 4Biomedical Research Artificial Intelligence and Neuroimaging lab, War Related Illness and Injury Study Center, War Related Illness Study Center, Veterans Affairs Medical Center, Washington, DC.
  5. 5Henry M. Jackson Foundation for the Advancement Military Medicine, Bethesda, MD.
  6. 6Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
  7. 7Cardiovascular Institute, Stanford University, Stanford, CA.
Read full textPDFDOICite

Abstract

Rationale & objective

The obesity paradox, in which a higher body mass index (BMI) is associated with better survival, has been observed in chronic disease populations. However, the interaction between BMI, cardiorespiratory fitness (CRF), and mortality in chronic kidney disease (CKD) remains incompletely understood. We examined the association between BMI, age-adjusted CRF, and all-cause mortality in a large CKD cohort.Study design

Retrospective cohort study.Setting & participants

13,521 predominantly male US veterans (97.4% male) with CKD from the Exercise Testing and Health Outcomes Study within the Veterans Affairs health care system.Predictors

BMI categories (normal weight <25.0, overweight 25.0-29.9, and obese ≥30.0 kg/m²) and age-adjusted CRF quartiles based on metabolic equivalents achieved during maximal exercise tolerance testing using the Bruce protocol. The index date was the date of exercise testing.Outcome

All-cause mortality.Analytical approach

Cox proportional hazards models adjusted for age, sex, diabetes mellitus, hypertension, and cardiovascular disease assessed mortality risk across BMI-fitness combinations, with normal BMI and least fit as references.Results

During a mean follow-up period of 7.4 years, 5,144 (38.0%) deaths occurred. A higher BMI was associated with a lower mortality risk: overweight (HR 0.82, 95% CI 0.70-0.95) and obese (HR 0.71, 95% CI 0.61-0.82) versus normal BMI. Higher CRF was associated with progressively lower mortality: moderate fit (HR 0.61, 95% CI 0.50-0.74) and most fit (HR 0.49, 95% CI 0.40-0.60) versus least fit. The combination of obese BMI and highest fitness was associated with a 64% lower mortality risk (HR 0.36, 95% CI 0.25-0.51).Limitations

Predominantly male veteran population; single baseline BMI and fitness measurements; observational design precludes causal inference.Conclusions

In this predominantly male veteran CKD cohort, a higher BMI was associated with lower all-cause mortality across all fitness levels. Age-adjusted CRF demonstrated a strong, graded inverse association with mortality independent of BMI. These observational findings support integrating fitness assessment into CKD management.

Related

  1. Can an Eight-Week Exercise Program for Young Women with Normal-Weight Obesity Improve Body Composition, Cardiorespiratory Fitness, and Selected Cardiometabolic Markers? A Randomized Controlled Trial
    Jae-Myun Ko, Wi-Young So, Tae-Hyung Lee
    MetabolitesPeer-reviewedCC BY 4.0PhysiologyCrossref
  2. Cardiorespiratory fitness is associated with cerebral oxygen extraction in Alzheimer’s disease
    Paul J. Kueck, Zachary D. Green, Raechel Camones +5
    Frontiers in aging neurosciencePeer-reviewedCC BYFull textGeneral medicineEurope PMC
  3. The obesity paradox in peritoneal dialysis: reassessing optimal BMI via longitudinal time in range analysis in a single-center cohort
    Meihua Wang, Xiaohong Zeng, Dehui Liu +2
    Frontiers in NutritionPeer-reviewedCC BY 4.0Full textGeneral medicinePMC
  4. Body mass index, diabetes, inflammation and survival in COVID-19: a retrospective study evaluating the obesity paradox in an urban hospital center
    Sanah Sadiq, Rashelle Ripa, Huaqing Zhao +1
    Frontiers in Clinical Diabetes and HealthcarePeer-reviewedCC BY 4.0Full textInfectious diseasePMC
  5. Pre-admission Nutritional Risk as an Independent Predictor of 28-Day Mortality After Hip Fracture: A Retrospective Cohort Study
    Gautham Sreekumar, Saurav Krishnan, Tharmesh Sivananthan +1
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{balantrapu2026obesity,
  title = {{The Obesity Paradox in Chronic Kidney Disease: Cardiorespiratory Fitness Is Associated With Mortality Independent of Body Mass Index.}},
  author = {Swathi Balantrapu and Peter Kokkinos and Immanuel B H Samuel and Andreas Pittaras and Charles Faselis and Jonathan Myers},
  journal = {Kidney medicine},
  year = {2026},
  month = jul,
  doi = {10.1016/j.xkme.2026.101471},
  url = {https://europepmc.org/article/MED/42909167},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The Obesity Paradox in Chronic Kidney Disease: Cardiorespiratory Fitness Is Associated With Mortality Independent of Body Mass Index.
AU  - Swathi Balantrapu
AU  - Peter Kokkinos
AU  - Immanuel B H Samuel
AU  - Andreas Pittaras
AU  - Charles Faselis
AU  - Jonathan Myers
PY  - 2026
DA  - 2026/07/15
JO  - Kidney medicine
DO  - 10.1016/j.xkme.2026.101471
UR  - https://europepmc.org/article/MED/42909167
AB  - Rationale & objective  The obesity paradox, in which a higher body mass index (BMI) is associated with better survival, has been observed in chronic disease populations. However, the interaction between BMI, cardiorespiratory fitness (CRF), and mortality in chronic kidney disease (CKD) remains incompletely understood. We examined the association between BMI, age-adjusted CRF, and all-cause mortality in a large CKD cohort.Study design  Retrospective cohort study.Setting & participants  13,521 predominantly male US veterans (97.4% male) with CKD from the Exercise Testing and Health Outcomes Study within the Veterans Affairs health care system.Predictors  BMI categories (normal weight <25.0, overweight 25.0-29.9, and obese ≥30.0 kg/m²) and age-adjusted CRF quartiles based on metabolic equivalents achieved during maximal exercise tolerance testing using the Bruce protocol. The index date was the date of exercise testing.Outcome  All-cause mortality.Analytical approach  Cox proportional hazards models adjusted for age, sex, diabetes mellitus, hypertension, and cardiovascular disease assessed mortality risk across BMI-fitness combinations, with normal BMI and least fit as references.Results  During a mean follow-up period of 7.4 years, 5,144 (38.0%) deaths occurred. A higher BMI was associated with a lower mortality risk: overweight (HR 0.82, 95% CI 0.70-0.95) and obese (HR 0.71, 95% CI 0.61-0.82) versus normal BMI. Higher CRF was associated with progressively lower mortality: moderate fit (HR 0.61, 95% CI 0.50-0.74) and most fit (HR 0.49, 95% CI 0.40-0.60) versus least fit. The combination of obese BMI and highest fitness was associated with a 64% lower mortality risk (HR 0.36, 95% CI 0.25-0.51).Limitations  Predominantly male veteran population; single baseline BMI and fitness measurements; observational design precludes causal inference.Conclusions  In this predominantly male veteran CKD cohort, a higher BMI was associated with lower all-cause mortality across all fitness levels. Age-adjusted CRF demonstrated a strong, graded inverse association with mortality independent of BMI. These observational findings support integrating fitness assessment into CKD management.
SN  - 2590-0595
ER  -