Research
Energy balance
In patients with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD), higher BMI is paradoxically associated with lower mortality rates, likely due to nutritional reserves and muscle mass.
If you have advanced kidney disease, being overweight might actually protect you from early death by providing essential energy and muscle reserves. Discuss weight management goals with your nephrologist, as the strategy may differ from general population advice.
ModerateQualifiesMEDIUM confidence
Considering the above evidence about the overwhelmingly deleterious effects of obesity on various disease processes, it is seemingly counterintuitive that obesity has been consistently associated with lower mortality rates in patients with advanced CKD and ESRD.
Why this rating
Based on observational studies showing an association, but mechanisms are complex and potentially confounded by muscle mass vs. fat.
Source
Obesity and kidney disease: hidden consequences of the epidemic
Csaba P. Kövesdy et al. · Internal Medicine Journal · 2017
DOI 10.1111/imj.13342
narrative_reviewCited 4×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
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