Obesity and Risk for Chronic Renal Failure

Abstract

Few large-scale epidemiologic studies have quantified the possible link between obesity and chronic renal failure (CRF). This study analyzed anthropometric data from a nationwide, population-based, case-control study of incident, moderately severe CRF. Eligible as cases were all native Swedes who were aged 18 to 74 yr and had CRF and whose serum creatinine for the first time and permanently exceeded 3.4 mg/dl (men) or 2.8 mg/dl (women) during the study period. A total of 926 case patients and 998 control subjects, randomly drawn from the study base, were enrolled. Face-to-face interviews, supplemented with self-administered questionnaires, provided information about anthropometric measures and other lifestyle factors. Logistic regression models with adjustments for several co-factors estimated the relative risk for CRF in relation to body mass index (BMI). Overweight (BMI > 25 kg/m 2 ) at age 20 was associated with a significant three-fold excess risk for CRF, relative to BMI <25. Obesity (BMI >30) among men and morbid obesity (BMI > 35) among women anytime during lifetime was linked to three-to four-fold increases in risk. The strongest association was with diabetic nephropathy, but two-to three-fold risk elevations were observed for all major subtypes of CRF. Analyses that were confined to strata without hypertension or diabetes revealed a three-fold increased risk among patients who were overweight at age 20, whereas the two-fold observed risk elevation among those who had a highest lifetime BMI of >35 was statistically nonsignificant. Obesity seems to be an important-and potentially preventable-risk factor for CRF. Although hypertension and type 2 diabetes are important mediators, additional pathways also may exist.

Pathological influence of obesity on renal structural changes in chronic kidney disease

“…Many studies investigated that BMI and blood pressure was associated with glomerular lesions in ORG patients [5,6,17,18]. In hypertensive patients, increasing renal tubular sodium reabsouption and glomerular hyperfiltration may cause glomerulomegaly [1].…”

“…Obesity should be put high on the list of potentially preventable causes of chronic kidney disease (CKD) [6]. Clinical features of obese patient without systemic disorders or apparent renal disorders, so-called obesity-related glomerulopathy (ORG), are associated with slowly progressive proteinuria.…”

“…Glomerulomegaly is also observed in the kidneys of diabetic nephropathy and hypertensive kidney [1,6,8]. An increase in glomerular volume is usually the consequence of glomerular hyperfiltration, and can be associated with expansion of capillary loops [8,9,10].…”

Obesity and kidney disease: hidden consequences of the epidemic

“…Higher BMI is associated with the presence [8] and development [9][10][11] of proteinuria in individuals without kidney disease. Furthermore, in numerous large population-based studies, higher BMI appears associated with the presence [8,12] and development of low estimated GFR [9][10][11][12][13], with more rapid loss of estimated GFR over time [14], and with the incidence of ESRD [15][16][17][18]. Elevated BMI levels, class II obesity and above, have been associated with more rapid progression of CKD in patients with pre-existing CKD [19].…”

The obese child in the Intensive Care Unit. Update

“…104 Over the past decades, a significant increase in obesity-associated glomerulopathy has also been described, and this is a condition that is exclusively related to excess weight. 105 In addition to the known relationship between MS and the development of T2DM and cardiovascular disease, 58 there is evidence of a significant relationship between MS and obesity and albuminuria and end-stage renal disease (ESRD), [106][107][108] which has been observed to appear early in youth. 109 It has been proposed that adipocytes are the driving force of glomerular hyperfiltration in obese patients ( Figure 2).…”