Anthropometric and Biochemical Determinants of Estimated Glomerular Filtration Rate in a Large Cohort of Obese Children
Anthropometric and Biochemical Determinants of Estimated Glomerular Filtration Rate in a Large Cohort of Obese Children
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DOI：
10.1053/j.jrn.2018.01.001
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发表时间：
2018-09-01
影响因子：
3.2
通讯作者：
del Giudice, Emanuele Miraglia
中科院分区：
文献类型：
--
作者：
Marzuillo, Pierluigi;Grandone, Anna;del Giudice, Emanuele Miraglia
目的：我们的目的是调查哪些临床和代谢因素可能影响估计的肾小球滤过率（eGFR）水平，评估一个没有怀疑原发性肾脏病的肥胖儿童的大人口。设计：回顾性，横断面研究。设置：儿科大学部门。主题：我们招募了2,957名肥胖儿童和青少年连续参加我们的部门在2000年1月和2017年之间。入选标准为体重指数（BMI）>第95百分位数和eGFR > 90 mL/min/1.73 m（2）。排除标准为继发性肥胖、eGFR < 90 mL/min/1.73 m2、尿试纸显示蛋白尿/血尿或服用任何药物。干预措施：体重、腰围、身高、腰高比（W/Hr）、BMI标准差评分（SDS）、青春期阶段、收缩压（SBP）和舒张压（DBP）、肥胖持续时间、胰岛素、eGFR，并进行稳态模型评价（HOMA-IR）。一个一般的线性模型进行了多变量analysis.Main结果测量：人口分为三分之一的BMI-SDS，W/Hr，SBP-和DBP-SDS，HOMA-IR，和肥胖的持续时间。我们比较了这些三分位数之间的eGFR水平。结果：eGFR水平在BMI-SDS和W/Hr三分位数之间显著增加。相反，在SBP-SDS、HOMA-IR和肥胖持续时间三分位数中，eGFR水平显著降低。在DBP-SDS三分位数之间未检测到eGFR水平的显著差异。青春期患者的eGFR值显著低于青春期前患者。eGFR方差的一般线性模型包括W/Hr、HOMA-IR、肥胖持续时间、青春期阶段、BMI-SDS和SBP-SDS作为协变量（模型R-2 39.7%;模型P < .00001）。它证实了直接关联的eGFR值与BMI-SDS和间接关联HOMA-IR，肥胖的持续时间，青春期阶段，和SBP-SDS.Conclusions：我们发现eGFR与BMI-SDS和负相关SBP-SDS，HOMA-IR，青春期阶段，和肥胖的持续时间。肥胖持续时间是与eGFR水平最显著相关的变量。(C)2018年由国家肾脏基金会，公司。All rights reserved.
Objective: We aimed to investigate which clinical and metabolic factors could influence the estimated glomerular filtration rate (eGFR) levels, evaluating a large population of obese children without suspect of primary kidney disease.Design: Retrospective, cross-sectional study.Setting: Pediatric university department.Subjects: We enrolled 2,957 obese children and adolescents consecutively attending our department between January 2000 and 2017. Inclusion criteria were body mass index (BMI) > 95th percentile and eGFR > 90 mL/min/1.73 m(2). Exclusion criteria were secondary forms of obesity, eGFR < 90 mL/min/1.73 m(2), proteinuria/hematuria at urine dipstick, or consumption of any medication.Interventions: Weight, waist circumference, height, waist to height ratio (W/Hr), BMI-standard deviation score (SDS), pubertal stage, systolic blood pressure (SBP) and diastolic blood pressure (DBP), duration of obesity, insulin, eGFR, and homeostasis model assessment (HOMA-IR) were obtained. A general linear model was performed for a multiple variable analysis.Main Outcome Measure: The population was divided in tertiles for BMI-SDS, W/Hr, SBP- and DBP-SDS, HOMA-IR, and duration of obesity. We compared eGFR levels among these tertiles.Results: The eGFR levels significantly increased across both BMI-SDS and W/Hr tertiles. Conversely the eGFR levels significantly decreased across SBP-SDS, HOMA-IR, and duration of obesity tertiles. No significant differences in eGFR levels across DBP-SDS tertiles were detected. Pubertal patients presented significantly lower eGFR values compared with prepubertal patients. A general linear model for eGFR variance including as covariates W/Hr, HOMA-IR, duration of obesity, pubertal stage, BMI-SDS, and SBP-SDS (model R-2 39.7%; model P < .00001) was performed. It confirmed a direct association of eGFR values with BMI-SDS and an indirect association with HOMA-IR, duration of obesity, pubertal stage, and SBP-SDS.Conclusions: We showed a positive correlation of eGFR with both BMI-SDS and a negative one with SBP-SDS, HOMA-IR, pubertal stage, and duration of obesity. The duration of obesity was the variable most significantly associated to eGFR levels. (C) 2018 by the National Kidney Foundation, Inc. All rights reserved.