Zhang M, Lu KR, Han JH, Gong GH. Glycemic status as a lens into heterogeneity of the obesity-cardiovascular risk in chronic kidney disease. World J Diabetes 2026; 17(6): 117887 [DOI: 10.4239/wjd.117887]
Corresponding Author of This Article
Guo-Hua Gong, PhD, Professor, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, No. 82 West College Road, Wenzhou 325035, Zhejiang Province, China. guohgong@wmu.edu.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
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review-article
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Zhang M, Lu KR, Han JH, Gong GH. Glycemic status as a lens into heterogeneity of the obesity-cardiovascular risk in chronic kidney disease. World J Diabetes 2026; 17(6): 117887 [DOI: 10.4239/wjd.117887]
World J Diabetes. Jun 15, 2026; 17(6): 117887 Published online Jun 15, 2026. doi: 10.4239/wjd.117887
Glycemic status as a lens into heterogeneity of the obesity-cardiovascular risk in chronic kidney disease
Min Zhang, Kong-Rui Lu, Jun-Hao Han, Guo-Hua Gong
Min Zhang, Kong-Rui Lu, Jun-Hao Han, Guo-Hua Gong, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Author contributions: Zhang M wrote the manuscript; Han JH and Lu KR discussed and revised the text; Gong GH designed the study and revised the manuscript. All authors have read and approved the final manuscript.
Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2024KY138; the Basic Research Project of Wenzhou Municipal Science and Technology Bureau, No. Y20240008; and the Key Laboratory of School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, No. JS2023003.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Guo-Hua Gong, PhD, Professor, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, No. 82 West College Road, Wenzhou 325035, Zhejiang Province, China. guohgong@wmu.edu.cn
Received: December 18, 2025 Revised: February 2, 2026 Accepted: April 17, 2026 Published online: June 15, 2026 Processing time: 175 Days and 8 Hours
Abstract
In the course of chronic kidney disease, the relationship between cardiovascular outcomes and obesity is modified by blood glucose status. A national study has deepened our understanding of this complex interaction. The study found that among patients with chronic kidney disease without diabetes, low body weight and central obesity are risk factors. In contrast, for patients with diabetic kidney disease, relatively low waist circumference and low body mass index are associated with increased disease risk. These findings highlight the existence of an obesity paradox and underscore the need to recognize that patients with diabetic kidney disease are in a catabolic state, which is unfavorable for the development of protective factors. Therefore, cardiovascular prevention strategies should be adjusted according to blood glucose status, and both body composition and blood glucose status should be assessed concurrently. This paper reviews the above findings and analyzes the implications of risk stratification in the management of diabetic kidney disease.
Core Tip: In patients with chronic kidney disease, there is a close relationship between cardiovascular risk and obesity indices, and blood glucose level is an important modulator of this relationship. Even in patients with a relatively low body weight, cardiovascular risk may be increased, challenging the notion that “thin is safe”. In clinical assessment, attention should be paid to both body mass index and waist circumference, along with evaluation of muscle atrophy and malnutrition, to enable individualized risk stratification.
