Underweight and low waist circumference prior to percutaneous coronary intervention increase the risk for end-stage renal disease: A Nationwide Population Based-cohort Study

Background The effect of obesity prior to percutaneous coronary intervention (PCI) on the development of end-stage renal disease (ESRD) is not clear. Methods Using nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without renal disease at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline body mass index (BMI) and six levels based on their waist circumference (WC; 5-cm increments). BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD. Results During a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (HR 1.331, 95%CI: 0.955–1.856) and low WC (< 80/<75) (HR 1.589, 95%CI: 1.379–1.831) showed the highest ESRD risk and the BMI 25 ~ 30 group showed the lowest ESRD risk (HR 0.604, 95%CI: 0542-0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM), BMI showed a U-shape relationship with ESRD risk at a baseline of 28.8 for BMI in the none-DM group and a reverse linear relationship in the DM group. However, low WC prior to PCI was risk factor in only DM group. Conclusions Underweight and low WC prior to PCI, which showed the increased ESRD risk in patients undergoing PCI, especially in those with DM. Trial Registration: Retrospectively registered