Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2026
Body roundness index and mortality risk in patients with chronic kidney disease: moving beyond the obesity paradox.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk association and diagnostic value of body roundness index for cardiovascular-kidney-metabolic-related outcomes: a systematic review and meta-analysis.Frontiers in endocrinology · 2026Pooled it
- Associations of Body Composition Biomarkers with Survival, Cardiovascular Events, and Progression in Persons with Chronic Kidney Disease: Insights from the Renal Risk in Derby Study.American journal of nephrology · 2026Article
- Visceral Adiposity and Histological Glomerular Changes: An Unrecognized Opportunity to Act.Kidney international reports · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundBody roundness index (BRI), an emerging anthropometric measure, has been shown to outperform body mass index (BMI) in predicting mortality risk in the general population. However, its prognostic value among patients with chronic kidney disease (CKD), where the obesity paradox may exist, remains unknown.
methodsThis observational study utilized data from the National Health and Nutrition Examination Survey. BRI was calculated using waist circumference (WC) and height, whereas BMI was calculated using body weight and height. Restricted cubic splines (RCSs) were applied to determine optimal cut-off points of BRI for all-cause and cardiovascular mortality in patients with CKD. Associations were examined using Cox proportional hazards models adjusted for potential confounders.
resultsOver a median follow-up of 6.6 years, 6240 patients with CKD (mean age 63 years, 43% men) were included, with 1922 all-cause and 715 cardiovascular deaths recorded. RCSs demonstrated J-shaped associations between BRI with mortality. A BRI >10 was associated with a significantly increased risk of all-cause {adjusted hazard ratio [aHR] 1.82 [95% confidence interval (CI) 1.34-2.47]} and cardiovascular mortality [aHR 2.15 (95% CI 1.27-3.62)] compared with the reference of 5.9-6.8 and 5.9-6.5, respectively, with dose-response trends (P for trend < .05). A BMI >30 was paradoxically associated with 44% and 40% lower risks of all-cause and cardiovascular mortality compared with the reference of 18.5-25, respectively. A WC >125 was associated with an increased risk of all-cause mortality [aHR 2.17 (95% CI 1.47-3.18)] but not with cardiovascular mortality [aHR 1.83 (95% CI 0.97-3.45)] compared with the reference of 95-105 cm. The associations between BRI >10 and mortality risks were particularly pronounced among younger adults <65 years of age or individuals with elevated albuminuria (P for interaction < .05).
conclusionsHigher BRI was independently associated with increased all-cause and cardiovascular mortality risk among patients with CKD, offering greater prognostic value for risk stratification than BMI or WC.
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