Body mass index is associated with altered renal hemodynamics in non-obese healthy subjects
Body mass index is associated with altered renal hemodynamics in non-obese healthy subjects
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DOI：
10.1111/j.1523-1755.2004.00351.x
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发表时间：
2004-01-01
影响因子：
19.6
通讯作者：
Navis, G
中科院分区：
文献类型：
--
作者：
Bosma, RJ;van der Heide, JJH;Navis, G
背景体重超重与肾脏风险增加有关。显性肥胖的数据表明肾脏血流动力学改变的作用。体重指数（BMI）是否也与非肥胖受试者的肾功能有关尚不清楚。我们研究了102名健康非肥胖（BMI < 30 kg/m2）受试者[59名男性，43名女性，平均年龄39（18- 69）岁]的BMI与肾血流动力学之间的关系。平均（+/- SD）BMI为24.0 +/- 2.8 kg/m2，平均动脉压（MAP）为93 +/- 11 mm Hg，肾小球滤过率（GFR，碘酞酸清除率）111 +/- 19 mL min/1.73 m（2），有效肾血浆流量（ERPF，马尿酸清除率）458 +/- 108 mL/min/1.73m（2），FF（GFR/ ERPF）0.25 +/- 0.04。单因素分析显示，BMI与ERPF/1.73m2体表面积（BSA）呈负相关（r = 0.46，P < 0.001），与GFR/1.73m2体表面积（BSA）呈负相关（r =-0.24，P = 0.013），与FF呈正相关（r = 0.45，P <0.001），与年龄呈正相关（r = 0.47，P < 0.001）。多因素分析显示，BMI和年龄是ERPF/1.73m2 BSA（阴性）和FF（阳性）的独立预测因素，P均< 0.05。年龄是GFR/1.73m2 BSA（阴性）的唯一预测因素。以身高（h）为指标分析肾功能，BMI与ERPF/ h呈负相关（r = 0.274，P = 0.005），与GFR/ h无相关性（r = 0.13，P = 0.899）。在多因素分析中，BMI（阳性）和年龄（阴性）是GFR/ h的独立预测因素（均P < 0.001）。年龄是ERPF/ h的唯一预测因素（阴性）。FF的预测因子（BMI和年龄，均为阳性）根据定义不变。BMI对肾功能的影响并不局限于明显的肥胖，因为在BMI < 30 kg/m2的受试者中，较高的BMI与较高的FF相关，即相对于ERPF较高的GFR。这表明传入/传出平衡改变和肾小球压力升高（即，例如，潜在不利的肾血液动力学特征），当叠加其他因素如高血压或糖尿病时，其可赋予增强的肾易感性。
Background. Weight excess is associated with increased renal risk. Data in overt obesity suggest a role for altered renal hemodynamics. Whether body mass index (BMI) is also relevant to renal function in non- obese subjects is unknown.Methods. We studied the relation between BMI and renal hemodynamics in 102 healthy, non- obese (BMI < 30 kg/ m 2) subjects [59 males, 43 females, mean age 39 (18- 69) years] in a post- hoc analysis of subjects evaluated as prospective kidney donors or as healthy volunteers in renal hemodynamic studies.Results. Mean ( +/- SD) BMI was 24.0 +/- 2.8 kg/ m(2), mean arterial pressure (MAP) 93 +/- 11 mm Hg, glomerular filtration rate (GFR, iothalamate clearance) 111 +/- 19 mL min/1.73m(2), effective renal plasma flow (ERPF, hippuran clearance) 458 +/- 108 mL/min/1.73m(2), FF (GFR/ ERPF) 0.25 +/- 0.04. On univariate analysis, BMI correlated negatively with ERPF/ 1.73m(2) body surface area (BSA) (r = 0.46; P < 0.001), GFR/1.73m(2) BSA (r = -0.24, P = 0.013) and positively with FF (r = 0.45, P < 0.001), and age (r = 0.47, P < 0.001). On multivariate analysis both BMI and age were independent predictors of ERPF/1.73m(2) BSA (negative) and FF (positive, all P < 0.05). Age was the only predictor of GFR/1.73m(2) BSA (negative). Analyzed for renal function indexed for height (h), BMI correlated negatively with ERPF/ h (r = 0.274, P = 0.005), but not with GFR/ h (r = 0.13, P = 0.899). On multivariate analysis both BMI (positive) and age (negative) were independent predictors for GFR/ h (both P < 0.001). Age was the only predictor for ERPF/ h (negative). Predictors for FF (BMI and age, both positive) were by definition unaltered.Conclusion. The impact of BMI on renal function is not limited to overt obesity, as in subjects with BMI < 30 kg/ m(2) a higher BMI is associated with higher FF, that is, a higher GFR relative to ERPF. This suggests an altered afferent/ efferent balance and higher glomerular pressure (i. e., a potentially unfavorable renal hemodynamic profile) that may confer enhanced renal susceptibility when other factors, such as hypertension or diabetes are superimposed.