Metabolically healthy obesity is associated with higher risk of both hyperfiltration and mildly reduced estimated glomerular filtration rate: the role of serum uric acid in a cross-sectional study

Abstract

Background The impact of metabolically healthy obesity (MHO) on kidney dysfunction remains debatable. Moreover, few studies have focused on the early stages of kidney dysfunction indicated by hyperfiltration and mildly reduced eGFR. Thus, we aimed to investigate the association between the MHO and early kidney dysfunction, which is represented by hyperfiltration and mildly reduced estimated glomerular filtration rate (eGFR), and to further explore whether serum uric acid affects this association. Methods This cross-sectional study enrolled 1188 residents aged ≥ 40 years old from Yonghong Communities. Metabolically healthy phenotypes were categorized based on Adult Treatment Panel III criteria. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2. Mildly reduced eGFR was defined as being in the range 60 < eGFR ≤ 90 ml/min/1.73m2. Hyperfiltration was defined as eGFR > 95th percentile after adjusting for sex, age, weight, and height. Results Overall, MHO accounted for 12.8% of total participants and 24.6% of obese participants. Compared to metabolically healthy non-obesity (MHNO), MHO was significantly associated with an increased risk of mildly reduced eGFR (odds ratio [OR] = 1.85, 95% confidence interval [CI] 1.13–3.01) and hyperfiltration (OR = 2.28, 95% CI 1.03–5.09). However, upon further adjusting for uric acid, the association between the MHO phenotype and mildly reduced eGFR was reduced to null. Compared with MHNO/non-hyperuricemia, MHO/non-hyperuricemia was associated with an increased risk of mildly reduced eGFR (OR = 2.04, 95% CI 1.17–3.58), whereas MHO/hyperuricemia was associated with an observably increased risk (OR = 3.07, 95% CI 1.34–7.01). Conclusions MHO was associated with an increased risk of early kidney dysfunction, and the serum uric acid partially mediated this association. Further prospective studies are warranted to clarify the causality.

Association between serum lipoprotein(a) and mildly reduced eGFR: a cross-sectional study

“…We conducted a cross-sectional study from December 2016 to December 2017. We recruited 1,328 permanent residents aged ≥ 40 years who had lived in the communities of Zhonglou District, Changzhou City, Jiangsu Province, China more than 6 months [ 23 , 24 ]. We excluded those with missing information on Lp(a), creatinine, and serum cystatin C (Scys) and eGFR < 60 mL/min/1.73 m 2 and deleted extreme values of Lp(a).…”

Comment on “Association of kidney disease index with all‐cause and cardiovascular mortality among individuals with hypertension”

“…Zhang et al reported that subjects with metabolically healthy obesity presented both a significantly reduced and increased eGFR, and the association became not significant by adjusting for serum uric acid. 3 Serum uric acid would interact with kidney function, and a mediation analysis may be one of the effective methods to evaluate the causal association between eGFR and mortality. 4 Fang et al 1 analyzed data in patients with hypertension, and cardio-renal effect on mortality would be a key point for the analysis.…”