Should clearance be normalised to body surface or to lean body mass?

Hallynck, Th.; H, Soep; Ja, Thomis; Boelaert, Johan R.; Daneels, R; Dettli, L

doi:10.1111/j.1365-2125.1981.tb01163.x

Cited by 143 publications

(88 citation statements)

References 8 publications

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“…Creatinine clearance was calculated (urine creatinine (mmol/l) Â urine volume (ml))/(plasma creatinine (mmol/l) Â min) and changes were compared after normalisation for lean body mass. 22,23 Statistical analysis Participants who failed to complete the entire 68-week study period were excluded from the final analysis and reported as Effect of a low-carbohydrate, high-protein diet GD Brinkworth et al dropouts. The final results are taken from all 43 subjects who remained in the study and attended the final clinic visit at week 68 (SP ¼ 22, HP ¼ 21).…”

Section: Biochemical Analysismentioning

confidence: 99%

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects

et al. 2004

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OBJECTIVE:To compare the long-term compliance and effects of two low-fat diets differing in carbohydrate to protein ratio on body composition and biomarkers of cardiovascular disease risk in obese subjects with hyperinsulinemia. DESIGN: Outpatient, parallel, clinical intervention study of two groups of subjects randomly assigned to either a standard protein (SP; 15% protein, 55% carbohydrate) or high-protein (HP; 30% protein, 40% carbohydrate) diet, during 12 weeks of energy restriction (B6.5 MJ/day) and 4 weeks of energy balance (B8.3 MJ/day). Subsequently, subjects were asked to maintain the same dietary pattern for the succeeding 52 weeks with minimal professional support. SUBJECTS: A total of 58 obese, nondietetic subjects with hyperinsulinemia (13 males/45 females, mean age 50.2 y, mean body mass index (BMI) 34.0 kg/m 2 , mean fasting insulin 17.8 mU/l) participated in the study. MEASUREMENTS: Body composition, blood pressure, blood lipids, fasting glucose, insulin, CRP and sICAM-1 were measured at baseline and at weeks 16 and 68. Urinary urea/creatinine ratio was measured at baseline, week 16 and at 3 monthly intervals thereafter. RESULTS: In total, 43 subjects completed the study with similar dropouts in each group (P ¼ 0.76). At week 68, there was net weight loss (SP À2.973.6%, HP À4.175.8%; Po0.01) due entirely to fat loss (Po0.001) with no diet effect. Both diets significantly increased HDL cholesterol concentrations (Po0.001) and decreased fasting insulin, insulin resistance, sICAM-1 and CRP levels (Po0.05). Protein intake was significantly greater in HP during the initial 16 weeks (Po0.001), but decreased in HP and increased in SP during 52-week follow-up, with no difference between groups at week 68, indicating poor long-term dietary adherence behaviour to both dietary patterns. CONCLUSION: Without active ongoing dietary advice, adherence to dietary intervention is poor. Nonetheless, both dietary patterns achieved net weight loss and improvements in cardiovascular risk factors.

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Section: Biochemical Analysismentioning

confidence: 99%

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects

et al. 2004

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“…To address the differences in body size, most studies advocate the adjustment of VO 2 max to LBM instead of body weight. Unfortunately, dual-energy x-ray ab- 18,19 With this approach, renal patients, including subjects with CKD stage 3 and 4, continued to have lower VO 2 max when compared with controls. It is important to point out that the formula used to estimate LBM was derived from measurements of healthy controls, which limits its applicability to our study population.…”

Section: Discussionmentioning

confidence: 99%

“…VO 2 max was also corrected for estimated LBM using the following equations: Male: LBM ϭ 1.10 ϫ weight Ϫ [128 ϫ (weight 2 /height 2 )]; Female: LBM ϭ 1.07 ϫ weight Ϫ [148 ϫ (weight 2 /height 2 )]. 18,19,39 The RQ was also determined at peak exercise. RQ, the ratio of carbon dioxide excreted relative to uptake of oxygen, is useful in assessing effort.…”

Section: Exercise Testingmentioning

confidence: 99%

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Weaver

Kimball

Knilans

et al. 2008

Journal of the American Society of Nephrology

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Adult and pediatric patients with ESRD have impaired maximum oxygen consumption (VO 2 max), a reflection of the cardiopulmonary system's ability to meet increased metabolic demands. We sought to determine factors associated with decreased VO 2 max in pediatric patients with different stages of CKD. VO 2 max was measured using a standardized exercise testing protocol in patients with stage 2 to 4 chronic kidney disease (CKD) (n ϭ 46), in renal transplant recipients (n ϭ 22), in patients treated with maintenance hemodialysis (n ϭ 12), and in age-matched healthy controls (n ϭ 33). VO 2 max was similar between children with stage 2 CKD and controls, whereas lower VO 2 max was observed among children with stage 3 to 4 CKD, those treated with hemodialysis, and transplant recipients. In univariate analysis, VO 2 max was significantly associated with body mass index, resting heart rate, C-reactive protein, serum triglycerides, serum creatinine, and measures of diastolic function; no significant associations with left ventricular structure or systolic function were identified. In multivariate regression analysis, patient category versus control and the presence of diastolic dysfunction were independent predictors of lower VO 2 max. These results suggest that aerobic capacity is decreased in the early stages of CKD in children and that lower VO 2 max can be predicted by the presence of diastolic dysfunction, even if systolic function is normal. Maximal aerobic capacity (VO 2 max) represents the cardiovascularsystem'sabilitytotakeup,distribute,andutilize oxygen to perform work during maximal exercise. Healthy individuals can sustain a three-fold increase in heart rate (HR) and a two-fold increase in stroke volume to generate maximal aerobic capacity. 1 Therefore, VO 2 max has been used to assess the capacity of the cardiovascular system to respond to metabolic challenge in numerous disease states including ESRD. 2,3 Impaired maximal aerobic capacity was observed in adult and adolescent patients with ESRD as well as after renal transplantation. [4][5][6][7] The significance of these findings was underscored by studies suggesting lower survival rates in adults with ESRD and decreased VO 2 max. 8 The impairedVO 2 maxinthesepatientswasassociatedwithseveralfactors,includinglowerserumalbumin,anemia,and chronic heart failure. 9 Symptomatic heart disease is a rare event in pediatric patients with CKD. However abnormal cardiac structure and function in children with CKD is well recognized. These patients have left ventricular (LV) diastolic dysfunction and increased LV mass even before the onset of ESRD. 10,11 LV systolic function is generally preserved at rest, but altered contractile reserve was observed during exercise in di-

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“…They found their daily CE rate based on BSA correlated with age (r ¼ 0.73) better than when based on LBM (r ¼ 0.49) or body weight (r ¼ 0.45). However, there is controversy whether creatinine clearance should be normalized to BSA or LBM (Hallynck et al, 1981), and LBM is discussed in the following section on obesity. The different offsets between Cockcroft and Gault (1976) and Remer et al (2002) for male and female can possibly be due to a combination of a small female sample (Cockcroft and Gault,n ¼ 18) and different methods of creatinine analysis.…”

Section: Effects Of Sample Error and Creatinine Measurement Errormentioning

confidence: 99%

Creatinine corrections for estimating children's and adult's pesticide intake doses in equilibrium with urinary pesticide and creatinine concentrations

Mage

Allen

Kodali

2007

J Expo Sci Environ Epidemiol

151

141

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A urine contaminant concentration per se has uncertain meaning for human health because of dilution by hydration. However, the estimation of the health-related daily intake dose of pollutant (mg/kg/day) that equilibrates with a spot urinary concentration of a pesticide residue or metabolite, or other analyte, can be made using creatinine-corrected toxicant levels (mg analyte/mg creatinine) multiplied by an estimate of the subjects' expected creatinine excretion rates (mg creatinine/kg/day). The objective was to develop a set of equations predicting a person's expected daily creatinine excretion (mg/kg) as a function of age, gender, race and morphometry, from birth to old age. We review the creatinine excretion literature where infants, children and adults provided 24 h total urine samples for creatinine analysis. Equations are developed for infants (r3 years), children (3-18 years) and adults (Z18 years) that match at 3 and 18 years. A series of equations that estimate daily creatinine excretion (mg/day) are developed that are piecewise continuous from birth through infancy through adolescence and through adulthood for males and females, and Black and White races. Complicating factors such as diet, health status and obesity are discussed. We propose that these equations, with caveat, can now be used with measured urine concentrations to consistently estimate the corresponding equilibrium intake doses of toxicants at ages from birth to 92 years for the healthy non-obese. We recommend that this system of equations be considered for future development and reporting of applied doses in mg/kg/day of pollutants and toxicants that are measured in urine samples, as in the National Health and Nutrition Examination Survey.

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Should clearance be normalised to body surface or to lean body mass?

Cited by 143 publications

References 8 publications

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Creatinine corrections for estimating children's and adult's pesticide intake doses in equilibrium with urinary pesticide and creatinine concentrations

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