Normalization of glomerular filtration rate in obese children
Normalization of glomerular filtration rate in obese children
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DOI：
10.1007/s00467-016-3367-8
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发表时间：
2016-08-01
影响因子：
3
通讯作者：
Azevedo, Ana
中科院分区：
文献类型：
--
作者：
Correia-Costa, Liane;Schaefer, Franz;Azevedo, Ana
肾小球滤过率（GFR）通常与体表面积（BSA）挂钩，但当应用于体型异常的受试者时，这可能导致结果偏倚。我们研究的目的是检查标准化的BSA和其他体型描述符对超重和肥胖儿童GFR测量和估计的影响。这是一项对313名8-9岁儿童的横断面研究。GFR通过24小时肌酐清除率（CrCl）测量，并使用联合Zappitelli公式从血清肌酐和胱抑素C （CysC）估计，两者均为绝对值，并根据各种体型描述符进行调整。研究人员对163名正常体重儿童、89名超重儿童和61名肥胖儿童进行了比较。与正常体重儿童相比，超重和肥胖儿童的平均绝对GFR（测量和估计）较高，而bsa调整的GFR较低。在正常体重儿童中拟合的线性回归模型显示，绝对GFR与身高的平方、理想体重（IBW）和由IBW得出的BSA之间同样密切相关。将GFR归一化为ibw衍生的BSA完全消除了超重和肥胖儿童GFR绝对值和BSA指数之间的差异。在研究肥胖儿童时，根据理想体重（而非实际体重）计算GFR与BSA的指数是一种很有前途的方法，可以避免矫枉过正。进一步的研究应该评估这种方法在整个年龄和BMI分布范围内的准确性。
Background Glomerular filtration rate (GFR) is conventionally indexed to body surface area (BSA), but this may lead to biased results when applied to subjects of abnormal body size. The aim of our study was to examine the impact of normalization to the BSA and alternative body size descriptors on measured and estimated GFR in overweight and obese children.This was a cross-sectional study of 313 children aged 8-9 years old. GFR was measured by 24-h creatinine clearance (CrCl) and additionally estimated from serum creatinine and cystatin C (CysC) using the combined Zappitelli formula, both as absolute values and adjusted to various body size descriptors. The results were compared between 163 normal-weight, 89 overweight and 61 obese children.Compared to the normal-weight children, mean absolute GFR (both measured and estimated) was higher in the overweight and obese children, whereas BSA-adjusted GFR was lower. Linear regression models fitted in normal-weight children revealed equally close associations between absolute GFR and squared height, ideal body weight (IBW) and BSA derived from IBW. Normalization of GFR to the IBW-derived BSA completely eliminated the discrepancy between absolute and BSA-indexed GFR in overweight and obese children.Indexing of GFR to BSA calculated from the ideal-rather than actual-body weight is a promising approach to avoid overcorrection when studying obese children. Further studies should assess the accuracy of this approach across the full range of age and BMI distribution.