Elevated weight-adjusted waist index (WWI) was independently associated with higher risks of all-cause and cardiovascular mortality in chronic kidney disease patients, with systemic inflammation (measured by neutrophil-to-lymphocyte ratio) partially mediating these associations.
Higher WWI was significantly and independently associated with increased risk of all-cause mortality in CKD patients.
Higher WWI was significantly and independently associated with increased risk of cardiovascular disease (CVD) mortality in CKD patients.
The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, partially mediated the association between WWI and all-cause mortality.
The study population consisted of 5582 CKD participants drawn from NHANES cycles spanning nearly two decades.
This research suggests that a measurement called the weight-adjusted waist index (WWI) — which reflects how fat is distributed around the midsection relative to body weight — can predict the risk of death from any cause and from heart disease in people with chronic kidney disease (CKD). Using data from nearly 20 years of a large U.S. national health survey (NHANES, 1999–2018) and involving over 5,500 CKD patients, the study found that as WWI increased, so did the risk of dying, even after accounting for other health factors. Importantly, this relationship was linear, meaning there was no threshold — higher WWI consistently meant higher risk. The study also found that part of the reason higher WWI leads to worse outcomes may be due to inflammation in the body. The researchers measured inflammation using the neutrophil-to-lymphocyte ratio (NLR), a blood test that reflects immune system activity, and found that it explained about 6.7% of the link between WWI and all-cause mortality. This suggests that central obesity in CKD patients may partly harm health by fueling chronic inflammation. This research suggests that measuring central fat distribution (using WWI) alongside markers of inflammation could help doctors identify CKD patients who are at greatest risk of dying, potentially enabling earlier or more targeted interventions. Since CKD patients already face a heavy burden of metabolic and cardiovascular complications, tools like WWI that are simple to calculate from basic body measurements may be practically useful in clinical settings.
Zhou H, Zhang X, Zhang W, Liu G, Wang H. (2026). Weight-adjusted waist index and all-cause and cardiovascular mortality in chronic kidney disease: A cohort study with mediation analysis of systemic inflammation.. Medicine. https://doi.org/10.1097/MD.0000000000050613