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However, its prognostic value among patients with chronic kidney disease (CKD), where the obesity paradox may exist, remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median follow-up of 6.6\u00a0years, 6240 patients with CKD (mean age 63\u00a0years, 43% men) were included, with 1922 all-cause and 715 cardiovascular deaths recorded. RCSs demonstrated J-shaped associations between BRI with mortality. A BRI &amp;gt;10 was associated with a significantly increased risk of all-cause {adjusted hazard ratio [aHR] 1.82 [95% confidence interval (CI) 1.34\u20132.47]} and cardiovascular mortality [aHR 2.15 (95% CI 1.27\u20133.62)] compared with the reference of 5.9\u20136.8 and 5.9\u20136.5, respectively, with dose-response trends (P for trend\u00a0&amp;lt;\u00a0.05). A BMI &amp;gt;30 was paradoxically associated with 44% and 40% lower risks of all-cause and cardiovascular mortality compared with the reference of 18.5\u201325, respectively. A WC &amp;gt;125\u00a0 was associated with an increased risk of all-cause mortality [aHR 2.17 (95% CI 1.47\u20133.18)] but not with cardiovascular mortality [aHR 1.83 (95% CI 0.97\u20133.45)] compared with the reference of 95\u2013105\u00a0cm. The associations between BRI &amp;gt;10 and mortality risks were particularly pronounced among younger adults &amp;lt;65\u00a0years of age or individuals with elevated albuminuria (P for interaction\u00a0&amp;lt;\u00a0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf237","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T12:57:37Z","timestamp":1762606657000},"page":"1118-1128","source":"Crossref","is-referenced-by-count":3,"title":["Body roundness index and mortality risk in patients with chronic kidney disease: moving beyond the obesity paradox"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7153-9159","authenticated-orcid":false,"given":"Changyuan","family":"Yang","sequence":"first","affiliation":[{"name":"University Medical Center Groningen, University of Groningen Department of Nephrology, , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biyi","family":"Liao","sequence":"additional","affiliation":[{"name":"Second Clinical College of Guangzhou University of Chinese Medicine State Key Laboratory of Traditional Chinese Medicine Syndrome, Chinese Medicine Guangdong Laboratory, Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Big Data Research Center of Chinese Medicine, Department of Nephrology, , Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5576-820X","authenticated-orcid":false,"given":"Priya","family":"Vart","sequence":"additional","affiliation":[{"name":"University Medical Center Groningen, University of Groningen Department of Clinical Pharmacy and Pharmacology, , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Johnson","sequence":"additional","affiliation":[{"name":"Australasian Kidney Trials Network, University of Queensland , Brisbane ,","place":["Australia"]},{"name":"Princess Alexandra Hospital Department of Kidney and Transplant Services, , Brisbane ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron T","family":"Gansevoort","sequence":"additional","affiliation":[{"name":"University Medical Center Groningen, University of Groningen Department of Nephrology, , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5073-9848","authenticated-orcid":false,"given":"Guobin","family":"Su","sequence":"additional","affiliation":[{"name":"Second Clinical College of Guangzhou University of Chinese Medicine State Key Laboratory of Traditional Chinese Medicine Syndrome, Chinese Medicine Guangdong Laboratory, Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Big Data Research Center of Chinese Medicine, Department of Nephrology, , Guangzhou ,","place":["China"]},{"name":"Karolinska Institute Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"University of Oxford Nuffield Department of Population Health, , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,8]]},"reference":[{"key":"2026052900270754800_bib1","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, regional, and national prevalence of adult overweight and obesity, 1990\u20132021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021","volume":"405","author":"Ng","year":"2025","journal-title":"Lancet"},{"key":"2026052900270754800_bib2","author":"Obesity and overweight. 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