Primacy of lowered baseline glomerular filtration rate as a risk for incident chronic kidney disease: A longitudinal study in Japanese subjects

Miyakoshi, Takahiro; Nakasone, Yasuto; Sato, Yuka; Yamauchi, Kazuyo; Hashikura, Rie; Takayama, Masayuki; Hirabayashi, Kazuko; Koike, Hideo; Moriya, Takuya; Aizawa, Toru

doi:10.1111/nep.12836

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Only 2 cohort studies evaluated CKD onset; therefore, we could not perform a quantitative analysis. 46,47 We performed univariate meta-regression to evaluate the association between risk of low eGFR due to an increment of 1 kg/m 2 BMI and mean baseline BMI. To include subjects who were more homogeneous in the analysis, we analyzed only studies on an Asian Pacific population because there were an adequate number of studies, and we found a significant increase in the effect size with an increasing mean baseline BMI (Supplementary Figure S7).…”

Section: Bmi and Development Of Ckd De Novomentioning

confidence: 99%

A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population

Garofalo

Borrelli

Minutolo

et al. 2017

Kidney International

279

206

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Obesity and chronic kidney disease (CKD) are public health priorities that share core pathophysiological mechanisms. However, whether high body mass index (BMI) increases risk of CKD de novo remains ill-defined. To evaluate the role of BMI in predicting CKD onset in the general adult population, we performed a systematic review and meta-analysis of PubMed and ISI Web of Science databases articles published between January 2000 and August 2016 without language restriction. We selected studies in adult individuals from a general population with normal renal function at baseline that reported the risk of low estimated glomerular filtration (eGFR) (under 60 mL/min/1.73m) and/or albuminuria (1+ at dipstick or an albumin creatinine ratio of 3.4 mg/mmol or more) as hazard ratio, odds ratio or relative risk related to obesity, overweight, or BMI as continuous value. A total of 39 cohorts covering 630, 677 participants with a mean follow-up of 6.8 years were selected. Obesity increased the relative risk, 95% confidence interval and heterogeneity (I) of developing low eGFR (1.28, 1.07-1.54, [I: 95.0%]) and albuminuria (1.51, 1.36-1.67, [I: 62.7%]). Increase of BMI unit was also associated with higher risk of low eGFR (1.02, 1.01-1.03, [I: 24.3%]) and albuminuria (1.02, 1.00-1.04, [I: 0%]). Conversely, overweight did not predict onset of either low eGFR (1.06, 0.94-1.21, [I: 50.0%]) or albuminuria (1.24, 0.98-1.58, [I: 49.4%]). Thus, a high BMI predicts onset of albuminuria without kidney failure (CKD stages 1-2) as well as CKD stages 3 and higher, the effect being significant only in obese individuals. Hence, our findings may have implications to improve risk stratification and recommendations on body weight control in the general population.

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Section: Bmi and Development Of Ckd De Novomentioning

confidence: 99%

A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population

Garofalo

Borrelli

Minutolo

et al. 2017

Kidney International

279

206

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown rituximab (RTX) to be a safe CS sparing therapy in difficult-to-treat SDNS. 1 Bruchfeld et al reported remission (complete remisssion (CR) or partial remission) in 15 of 16 adult patients with steroid dependent minimal change disease (MCD) with RTX therapy. 1 Ruggenenti et al 2 reported favourable response to RTX therapy in patients (both adult and children) with steroid dependent MCD/focal segmental glomerulosclerosis (FSGS)/ mesangioproliferative glomerulonephritis.…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…

Miyakoshi et al 1 conducted a prospective study of risk factors for incident chronic kidney disease (CKD) in 17 153 healthy subjects. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m 2 or positive dipstick proteinuria.

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confidence: 99%

Baseline estimated glomerular filtration rate and subsequent incident chronic kidney disease

Kawada¹

2017

Nephrology

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Miyakoshi et al. 1 conducted a prospective study of risk factors for incident chronic kidney disease (CKD) in 17 153 healthy subjects. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m 2 or positive dipstick proteinuria. The number of incident CKD was 1002 (5.8 %), and lower eGFR, male gender, serum uric acid, lower red cell count, age, body mass index (BMI) and systolic blood pressure were significant risks for incident CKD. I have some concerns on their study with special reference to statistical validity.First, the authors used a Validation cohort (n = 5718) and presented hazard ratios (HRs) of baseline eGFR with 60-69 and with 70-79 for CKD, which were extremely high with wide 95% confidence intervals. Although the total number of CKD events is enough for calculating HRs, I am afraid of unstable estimates by their statistical models. Caution should be paid to the applicability of Cox regression models by checking proportionality. 2 Second, the authors used Derivation cohort (n = 11 435) and applied receiver operating characteristic (ROC) curve analysis for the prediction of incident CKD. By using this statistical method, the authors concluded that lowered baseline eGFR alone (Model 2) was sufficient for predicting incident CKD without using other factors. I speculate that incident CKD was determined mainly by eGFR and baseline eGFR would contribute to subsequent incident CKD. But there is a problem for excluding other significant variables only by ROC curve analysis. In addition, there is a fluctuation of eGFR for predicting actual GFR. 3 Taken together, further study is needed to confirm the usefulness of eGFR without other contributors for incident CKD.Finally, the authors did not use BMI in their statistical models 1 and 3 in the Derivation cohort. As there is a report that CKD risk increases with the growth of BMI in metabolically healthy individuals, 4 BMI should also be considered for the prediction of incident CKD. CONFLICT OF INTERESTI declare that there is no conflict of interest in this study.

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Serum γ-glutamyltransferase and subsequent chronic kidney disease in a prospective study

Kawada

2017

Int Urol Nephrol

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Primacy of lowered baseline glomerular filtration rate as a risk for incident chronic kidney disease: A longitudinal study in Japanese subjects

Abstract: Seven risk factors for incident CKD were identified in Japanese health examinees. However, lowered baseline eGFR outweighed other risks to the degree that eGFR alone was suffice for CKD prediction.

Cited by 6 publications

References 20 publications

A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population

A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population

Baseline estimated glomerular filtration rate and subsequent incident chronic kidney disease

Serum γ-glutamyltransferase and subsequent chronic kidney disease in a prospective study

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