タカハシ　リナ   TAKAHASHI Rina   高橋　利奈    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
言語種別	英語
発表タイトル	Exploring the Lipid Pathway in the Obesity Paradox: LDL as a Nonmediator Between Body Mass Index and Mortality in Patients with CKD
会議名	Kidney Week 2025
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Takahashi Rina, Kovesdy Csaba P, Tran Diana, Simon Lewis, Ismail Adnan M, Sumida Keiichi, Rhee Connie, Kalantar-Zadeh Kamyar,
発表年月日	2025/11/06
国名	アメリカ合衆国
開催地 （都市, 国名）	Houston, USA
開催期間	2025/11/05～2025/11/09
学会抄録	Journal of the American Society of Nephrology : JASN 36(10S)
概要	Background Both obesity and lipid paradoxes have been reported in CKD, but the interaction between BMI, lipid levels, and mortality remains unclear. This study aimed to evaluate the association between BMI and LDL-C, examining the hypothesis that LDL-C mediates the relationship between BMI and all-cause mortality in patients with CKD. Methods We analyzed 30,559 U.S. veterans with incident CKD from the national TRI-CKD cohort (2004–2018). Incident CKD was defined by two outpatient eGFR values <60 mL/min/1.73m2 at least 90 days apart, both ≥25% below baseline. Patients were categorized into five BMI groups: <20, 20–25 (reference), 25–30, 30–35, and ≥35 kg/m2. Baseline BMI and LDL-C were assessed at CKD incidence. Cox proportional hazards models were used to evaluate the association between BMI and all-cause mortality, adjusting for demographics, comorbidities, labs including eGFR, and medications. Mediation analysis was conducted to estimate the mediation effect of LDL-C on the association between BMI and mortality. Results Patients with higher BMI were younger (71.5 to 64.3), while mean eGFR remained relatively stable (52.5 to 55.1 mL/min/1.73m2), and the proportion of Black patients peaked at 4.5% in 25–30 kg/m2. A reverse U-shaped association was observed between BMI and LDL-C, with LDL-C peaking in 25-30 kg/m2. BMI showed a U-shaped association with all-cause mortality, with the lowest risk observed in 30–35 kg/m2 in all models. Mediation analysis revealed no significant mediation effect of LDL-C (β = 0.0003 for BMI 30–35). Conclusion In patients with CKD, there was no significant mediation effect of LDL-C on the association between BMI and mortality, although the obesity paradox persisted, with the greatest survival among the patients with a BMI of 30–35 kg/m2. These findings suggest that LDL does not significantly explain the obesity paradox and highlight the need to explore other underlying mechanisms in CKD.