Chronic kidney disease (CKD) is defined as the permanent loss of kidney function and is characterised by a glomerular filtration rate (GFR) below 60 ml/min/1.73 m2.1 This disorder affects approximately 10% of the world’s adult population, which is why it is considered a serious public health problem.2 CKD is expected to become the fifth leading cause of death worldwide by 2040. According to the 2021 World Atlas of Kidney Health, the prevalence of CKD in Latin America was 9.9% (95% CI = 8.75%–11.1%). The country with the highest prevalence was Puerto Rico (15.4%); Mexico was in fourth position with a rate of 11.8%.3 The estimated annual cost for CKD care in Mexico was US$9000 per patient. This expense placed CKD as the most costly chronic disease for the Mexican public health system.4

One of the main modifiable risk factors for the development of CKD is obesity.5, 6 A meta-analysis carried out in cohorts from 40 countries with data collected from 1970 to 2017 demonstrated that high body mass index (BMI), waist circumference (WC) and waist-to-height ratio are independent risk factors that affect the GFR.7 After adjusting for age, gender, race and smoking, the risk indices obtained in this study by comparing different indices (30, 35, and 40 kg/m2) against one of 25 kg/m2, were statistically significant, with values of 1, 18, 1.69 and 2.02 respectively.7 Recent studies have shown that body fat distribution is relevant to kidney function. Central or abdominal obesity has been associated with a greater risk of a reduction in GFR. A retrospective study of 14,529 men and 10,561 women recruited in China from 2013 to 2015 showed that visceral obesity was independently associated with deterioration in kidney function in men and women of all ages, except men under the age of 45.8

Obesity can lead to hyperfiltration syndrome (≥130 ml/min/1.73 m2), deriving from haemodynamic alterations caused by the increase in body volume, which generates an increase in renal function and activity.9 At the same time, the increase in adipose tissue in the abdominal cavity exerts constant pressure on the kidneys, activating the sympathetic nervous system and stimulating the renin–angiotensin–aldosterone system (RAAS), which increases sodium reabsorption, altering natriuresis and expanding the extracellular volume, resulting in the long term in a decrease in GFR.6, 9, 10

In addition to obesity, type 2 diabetes mellitus (T2DM) and hypertension (HTN) are closely related to the development of CKD.11, 12, 13 In Mexico, it is estimated that three out of every 10 people with T2DM or HTN have some impairment in kidney function.14 The aim of this study was therefore to identify the risk factors related to the decrease or increase in GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLR), with emphasis on body fat, blood glucose control, the duration of diabetes and other relevant risk factors.