The effect of one year lifestyle intervention on eGFR in children and adolescents with overweight, obesity and morbid obesity

Dam, Mark van; Rijks, Jesse; Dorenbos, Elke; Horuz, Flore; Dael, Karin van; Vreugdenhil, Anita

doi:10.1038/s41598-019-40767-4

Cited by 13 publications

(11 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…showing that subjects with severe obesity have higher measured creatinine clearance and eGFR than people of normal weight. 24,25 In fact, in severe obesity, BMI reflects not only a disproportionate amount of fat mass, but also an increase in lean mass, which is known to provide the greatest contribution to the circulating levels of creatinine. 22 Our study shows a strong association between lean mass and risk of HF, similarly to previous reports in morbidly obese patients.…”

Section: Discussionmentioning

confidence: 99%

Glomerular hyperfiltration in morbid obesity: Role of the inflammasome signalling

et al. 2022

View full text Add to dashboard Cite

Aim Obesity is associated with glomerular hyperfiltration which may precede the development of overt renal damage. Few studies evaluated the link between inflammasome signalling and hyperfiltration. The aim is to evaluate the relationship between IL1‐β/Caspase‐1, insulin sensitivity and hyperfiltration in subjects with severe obesity, before and after weight loss. Methods Forty‐six patients with BMI > 35 kg/m2, without type‐2‐diabetes or hypertension, were evaluated at baseline and 6 months after bariatric surgery with oral glucose tollerance test, bioimpedance analysis and blood tests. The eGFR was calculated according to EPIcr‐cys formula and insulin sensitivity by Oral Glucose Insulin Sensitivity. IL‐1β/Caspase‐1 were measured with the ELISA‐kit. HF was defined as eGFR ≥ 140 ml/min (non‐indexed for BSA). Results Sixteen subjects at baseline had hyperfiltration, with a higher insulin resistance, BMI, lean mass and plasma levels of IL‐1β/Caspase‐1. After surgery, there was a reduction in BMI and improvement in insulin resistance in all patients. However, in 8 of 16 patients hyperfiltration persisted and IL‐1β/Caspase‐1 levels did not decrease (3.22 ± 0.79 vs. 3.13 ± 1.03 and 23.7 ± 12.1 vs. 20.6 ± 9.1, pre vs. post, pg/ml), while cytokines normalized in all the other patients in parallel with the eGFR. In a logistic regression model, correcting for the main covariates, lean mass and IL‐1β before surgery (p = .01 and p = .03, respectively), were the only predictors of hyperfiltration. Conclusion Weight loss is effective in reducing hyperfiltration in most, but not all patients. Hyperfiltration remains unchanged in subjects who do not have a reduction in IL‐1β/Caspase‐1, suggesting a pathogenetic role of the inflammasome signalling in the early stages of nephropathy.

show abstract

Section: Discussionmentioning

confidence: 99%

Glomerular hyperfiltration in morbid obesity: Role of the inflammasome signalling

et al. 2022

View full text Add to dashboard Cite

show abstract

“…5 Lifestyle modification and bariatric surgery can reverse hyperfiltration, reducing GFR for patients with eGFR >90 mL/min following the intervention. 41,42 43…”

Section: Discussionmentioning

confidence: 99%

Obesity Related Glomerulopathy: weighing in the effect of Body Surface Area

Bielopolski

Singh

et al. 2021

Preprint

View full text Add to dashboard Cite

Importance: Obesity related glomerulopathy (ORG), part of the cardiorenal spectrum, has an early reversible stage of hyperfiltration. Early identification in the obese adolescent population provides an opportunity to reverse the damage. Objective: Age appropriate formulae for estimated glomerular filtration rate (eGFR), are standardized to ideal body surface area (BSA) and provide assessment of renal function in mL/min/1.73 m2 units, may underestimate prevalence of early ORG. We investigated whether adjusting eGFR to actual BSA more readily identifies early ORG. Design: Cross sectional cohort study. Data were collected between 2011-2015 and analysis was performed between January to November 2020. Setting: Electronic health records clinical data base from 12 academic health centers and community health centers in the New York metropolitan area. Participants: 22,417 women and girls ages 12 to 21 years for whom data of body measurements and renal function were available. Main Outcome and measures: The hypothesis was generated using previously collected health record data. eGFR was calculated in two ways: BSA standardized eGFR according to KDIGO recommended formula; and Absolute eGFR adjusted to individual BSA. Hyperfiltration was defined above a threshold of 135mL/min/1.73 m2 or 135 mL/min, respectively. The prevalence of hyperfiltration according to each formula was assessed in parallel to 24-hour urine creatinine. Results: 22,417 female adolescents mean age 17 with high prevalence of underrepresented populations (32.6% African American, 12.8% Caucasians and 40.4% Hispanic) were evaluated. Serum creatinine values and hyperfiltration rates according to BSA-standardized eGFR were similar,13.4-15.3%, across Body Mass Index (BMI) groups. Prevalence of hyperfiltration determined by Absolute eGFR differed across groups: Underweight 2.3%; Normal 6.1%; Overweight 17.4%; Obese 31.4%. This trend paralleled the rise in 24-hour urine creatinine across BMI groups. Conclusions and relevance: Absolute eGFR more readily identifies early ORG compared to currently used formulae, which are adjusted to an archaic value of a BSA, not representative of current population BMI measures. The high proportion of underrepresented populations in this study accounts for the higher-than-expected obesity rates and should raise awareness for missed opportunities for screening, early diagnosis, and intervention particularly in young Black adults.

show abstract

“…Weight-loss interventions slow or reverse early CKD progression, in adults and children (72)(73)(74). Pre-bariatric surgery data of 242 adolescents from the "Teen-Labs" study show microalbuminuria in 14%, macroalbuminuria in 3%, serum cystatin C-based eGFR < 60 mL / min / 1.73 m 2 in 3% and eGFR > 150 mL / min / 1.73 m 2 in 7.1%.…”

Section: Obesity and The Kidneymentioning

confidence: 99%

“…Unfortunately, with the exception GFR determinations based on plasma disappearance of an intravenous injection of a low molecular weight substance that, on account of their precision, are routinely used for clinical research, there is no agreement on which is the best GFR determination equation to be used in children, adults or across the life span, as demonstrated by the multiple equations described above. This dilemma is expressed in a recent study, in obese children, in which the detection of changes in eGFR over time in response to therapeutic interventions were detectable only with the utilization of a height independent eGFR equation ( 74 ). Of note, another pediatric option of height independent GFR estimation is the equation proposed by the British Columbia Children's Hospital (BCCH; eGFR-BCCH), which in comparison to Potttel's equation might yield inferior results ( 76 ).…”

Section: Obesity and The Kidneymentioning

confidence: 99%

Obesity Facts and Their Influence on Renal Function Across the Life Span

Koch

2021

Front. Med.

View full text Add to dashboard Cite

Obesity is a chronic disease, with a rapidly increasing prevalence worldwide. Body mass index (BMI) provides the most useful population-level measure of overweight and obesity. For adults, overweight is defined as a BMI (Kg/m2) ≥ 25, and obesity as a BMI ≥ 30, for non-Asians and ≥ 27.5 for Asians. Abdominal obesity can be defined as a waist circumference equal to or higher than 102 cm for men and ≥88 cm for women. The definition of children and adolescents BMI changes with age and sex. Obesity may be exogenous or endogenous obesity, the latter is multifactorial and predominantly manifested during childhood. Presently, overweight and obesity are linked to more deaths worldwide than underweight. The total kidney glomerular filtration rate (GFR) is determined by the sum of nephrons and the GFR within each nephron or single nephron GFR. In clinical practice, GFR is more frequently calculated by GFR estimating equations based upon the plasma levels of creatinine, cystatin C, or both. The measured value of plasma creatinine is strongly influenced by non-GFR factors, by its tubular and gastrointestinal secretion, and by the problems associated with the lack of standardization of creatinine's laboratory assay discrediting it as an ideal GFR biomarker. Unlike creatinine, cystatin C plasma levels are mainly determined by GFR. Obesity may affect the kidney, via development of systemic arterial hypertension and/or diabetes mellitus, or directly, by ectopic accumulation of adipose tissue in the kidney. As obesity is a clinical condition associated with altered body composition, creatinine may not be the ideal biomarker for GFR measurement in obese individuals.

show abstract

The effect of one year lifestyle intervention on eGFR in children and adolescents with overweight, obesity and morbid obesity

Cited by 13 publications

References 34 publications

Glomerular hyperfiltration in morbid obesity: Role of the inflammasome signalling

Glomerular hyperfiltration in morbid obesity: Role of the inflammasome signalling

Obesity Related Glomerulopathy: weighing in the effect of Body Surface Area

Obesity Facts and Their Influence on Renal Function Across the Life Span

Contact Info

Product

Resources

About