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However, whether underweight status is associated with an increased risk of developing end\u2010stage kidney disease is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 9\u00a0845\u00a0420 participants aged \u226520\u00a0years who underwent health checkups were identified from the Korean National Health Insurance Service database and analysed. Individuals with underweight (body mass index [BMI]\u00a0&lt;\u00a018.5\u00a0kg\/m<jats:sup>2<\/jats:sup>) and obesity (BMI\u00a0\u2265\u00a025\u00a0kg\/m<jats:sup>2<\/jats:sup>) were categorized according to the World Health Organization recommendations for Asian populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a mean follow\u2010up period of 9.2\u00a0\u00b1\u00a01.1\u00a0years, 26\u00a0406 participants were diagnosed with end\u2010stage kidney disease. After fully adjusting for other potential predictors, the moderate to severe underweight group (&lt;17\u00a0kg\/m<jats:sup>2<\/jats:sup>) had a significantly higher risk of end\u2010stage kidney disease than that of the reference (normal) weight group (adjusted hazard ratio, 1.563; 95% confidence interval, 1.337\u20131.828), and competing risk analysis to address the competing risk of death also showed the similar results (adjusted hazard ratio, 1.228; 95% confidence interval, 1.042\u20131.448). Compared with that of the reference BMI group (24\u201325\u00a0kg\/m<jats:sup>2<\/jats:sup>), the adjusted hazard ratios for end\u2010stage kidney disease increased as the BMI decreased by 1\u00a0kg\/m<jats:sup>2<\/jats:sup>. In the sensitivity analysis, sustained underweight status or progression to underweight status over two repeated health checkups, when compared with normal weight status, had a higher hazard ratio for end\u2010stage kidney disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Underweight status is associated with an increased risk of end\u2010stage kidney disease, and this association gradually strengthens as BMI decreases.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13297","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T10:59:59Z","timestamp":1690541999000},"page":"2184-2195","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Underweight status and development of end\u2010stage kidney disease: A nationwide population\u2010based study"],"prefix":"10.1002","volume":"14","author":[{"given":"Chang 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