How unmeasured muscle mass affects estimated GFR and diagnostic inaccuracy

Nankivell, Brian J.; Nankivell, Lachlan F.J.; Elder, Grahame J.; Gruenewald, Simon M.

doi:10.1016/j.eclinm.2020.100662

Cited by 42 publications

(35 citation statements)

References 30 publications

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“…Aging and obesity lead to muscle atrophy, and a recent animal study demonstrated that the accumulation of perimuscular adipose tissue accelerated muscle fiber atrophy by increasing proteolysis and cellular senescence [ 44 ]. Muscle mass has been independently correlated with serum creatinine [ 45 ], which is a significant determinant when estimating GFR using the four-variable Modification of Diet in Renal Disease study equation [ 18 ]. Therefore, people with obesity and decreased muscle mass may have higher baseline eGFR due to a low serum creatinine level.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

Chen²,

Wu³

et al. 2022

Biomedicines

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A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.

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Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

Chen²,

Wu³

et al. 2022

Biomedicines

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“…Reduced glomerular filtration rate is a defining parameter of CKD and could be estimated from serum creatinine levels [ 44 ]. Notably, serum creatinine may reflect more than just kidney function as a metabolite from muscle metabolism [ 45 ]. Therefore, more alternative kidney function biomarkers need to be considered, of which BUN is the most commonly used in clinical studies [ 46 ].…”

Section: Methodsmentioning

confidence: 99%

Effects of Selenium on Chronic Kidney Disease: A Mendelian Randomization Study

Zhang

et al. 2022

Nutrients

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Background: Previous observational studies have shown that there is a controversial association between selenium levels and chronic kidney disease (CKD). Our aim was to assess the causal relationship between selenium levels and CKD using Mendelian randomization (MR) analysis. Methods: We used the two-sample Mendelian randomization (MR) method to analyze the causal role of selenium levels on CKD risk. The variants associated with selenium levels were extracted from a large genome-wide association study (GWAS) meta-analysis of circulating selenium levels (n = 5477) and toenail selenium levels (n = 4162) in the European population. Outcome data were from the largest GWAS meta-analysis of European-ancestry participants for kidney function to date. Inverse variance weighted (IVW) method was used as the main analysis and a series of sensitivity analyses were carried out to detect potential violations of MR assumptions. Results: The MR analysis results indicate that the genetically predicted selenium levels were associated with decreased estimated glomerular filtration (eGFR) (effect = −0.0042, 95% confidence interval [CI]: −0.0053–0.0031, p = 2.186 × 10−13) and increased blood urea nitrogen (BUN) (effect = 0.0029, 95% confidence interval [CI]: 0.0006–0.0052, p = 0.0136) with no pleiotropy detected. Conclusions: The MR study indicated that an increased level of selenium is a causative factor for kidney function impairment.

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“…Major limitation of the creatinine-based detection is its latency (days later) to show the onset of AKI, because the Creat Se value increases only when extensive glomerular/tubular involvement occurs. In addition, the detection of Creat Se is affected by factors such as decreased muscle mass and malnutrition [39][40][41]. If the initial Creat Se is low, the GFR Creat is not sensitive enough to properly detect AKI.…”

Section: Discussionmentioning

confidence: 99%

The role of urinary N-acetyl-β-D-glucosaminidase in early detection of acute kidney injury among pediatric patients with neoplastic disorders in a retrospective study

et al. 2022

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Background The 1-year cumulative incidence of AKI reportedly is high (52%) in pediatric neoplastic disorders. About half of these events occur within 2 weeks. However, subclinical AKI episodes may remain unrecognized by the conventional creatinine-based approaches. We investigated the diagnostic value of urinary N-acetyl-β-D-glucosaminidase (uNAG) as an early marker of acute kidney injury (AKI). Methods In our retrospective study, 33 children with neoplastic disorders were inculded who had serial uNAG tests (at least 5 samples/patient) with a total of 367 uNAG measurements. Renal function was determined by cystatin-C and creatinine based GFR, and relative increase of uNAG index (uNAGRI). We focused on detecting both clinical and subclinical AKI episodes (according to Biomarker-Guided Risk Assessment using pRIFLE criteria and /or elevated uNAG levels) and the incidence of chronic kidney damage. Results Sixty episodes in 26 patients, with positivity at least in one parameter of kidney panel, were identified during the observation period. We detected 18/60 clinical and 12/60 subclinical renal episodes. In 27/60 episodes only uNAG values was elevated with no therapeutic consequence at presentation. Two patients were detected with decreased initial creatinine levels with 3 „silent” AKI. In 13 patients, modest elevation of uNAG persisted suggesting mild, reversible tubular damage, while chronic tubuloglomerular injury occurred in 5 patients. Based on ROC analysis for the occurence of AKI, uNAGRI significantly indicated the presence of AKI, the sensitivity and specificity are higher than the changes of GFRCreat. Serial uNAG measurements are recommended for the reduction of the great amount of false positive uNAG results, often due to overhydratation. Conclusion Use of Biomarker-guided Risk Assessment for AKI identified 1.5 × more clinical and subclinical AKI episodes than with creatinine alone in our pediatric cancer patients. Based on the ROC curve for the occurence of AKI, uNAGRI has relatively high sensitivity and specificity comparable to changes of GFRCysC. The advantage of serial uNAG measurements is to decrease the number of false positive results. Trial registration The consent to participate is not applicable because it was not reqired for ethical approval and it is a retrospectiv study.

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How unmeasured muscle mass affects estimated GFR and diagnostic inaccuracy

Cited by 42 publications

References 30 publications

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

Effects of Selenium on Chronic Kidney Disease: A Mendelian Randomization Study

The role of urinary N-acetyl-β-D-glucosaminidase in early detection of acute kidney injury among pediatric patients with neoplastic disorders in a retrospective study

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