Othman Muftah, Kawar Bisher, El Nahas A Meguid
Sheffield Kidney Institute, Northern General Hospital Trust, University of Sheffield, Sheffield, UK.
Nephron Clin Pract. 2009;113(1):c16-23. doi: 10.1159/000228071. Epub 2009 Jul 10.
There is increasing awareness of the impact of obesity on chronic diseases including chronic kidney disease (CKD). Until recently, a limited number of epidemiologic studies have examined the association between obesity and CKD. We conducted a retrospective cohort study to evaluate whether obesity impacts on the rate of non-diabetic CKD progression.
The medical records of 125 non-diabetic CKD patients in the Sheffield Kidney Institute, Sheffield, UK, who have been followed-up for around 10 years, were reviewed. Various socio-demographic, clinical and biochemical parameters were retrospectively collected from the patients' database. Participants were categorized into normal weight, overweight and obese groups. Multivariate regression analysis was used for modelling with estimated glomerular filtration rate (eGFR) reduction per year as the dependent variable to evaluate the impact of obesity (BMI) on CKD progression.
Patients studied were mostly CKD stage 3 with a mean GFR of 36.2 ml/min/1.73 m(2) for the control group and 44.3 ml/min/1.73 m(2) for those who were overweight or obese. Baseline diastolic and mean arterial blood pressure were significantly higher in overweight than normal weight CKD patients (p = 0.009 and p = 0.014 respectively). On follow-up, systolic, diastolic and mean arterial blood pressure were significantly higher in overweight (p = 0.03, p = 0.005 and p = 0.003, respectively) and obese (p = 0.008, p = 0.022 and p = 0.003, respectively) compared to normal weight CKD patients. Mean follow-up triglycerides level was significantly higher in obese than normal weight patients (p = 0.042). The frequency of CKD progression based on eGFR fall per year (>1 ml/min/1.73 m(2)/year) was 62.5% in overweight and 79.5% in obese compared to 44.7% in normal weight CKD patients (p = 0.007). However, no significant difference in the rate of progression (fall of eGFR ml/min/1.73 m(2)/year) was observed between the three groups. On multivariate regression analysis, adjusted for other covariates (age, BP and proteinuria), baseline BMI was an independent predictor of CKD progression (fall in eGFR, ml/min/1.73 m(2)/year) (R(2) = 0.122 and p < 0.001). Percentage changes in BMI over the observation period did not affect the rate of eGFR decline. Young age also predicted a faster CKD progression.
Baseline BMI and young age are strongly and independently associated with faster CKD progression based on the annual rate of eGFR fall. Prospective studies to investigate the relationship between BMI and CKD and its complications are warranted.
肥胖对包括慢性肾脏病（CKD）在内的慢性疾病的影响正日益受到关注。直到最近，仅有少数流行病学研究探讨了肥胖与CKD之间的关联。我们进行了一项回顾性队列研究，以评估肥胖是否会影响非糖尿病CKD的进展速度。
回顾了英国谢菲尔德肾脏研究所125例非糖尿病CKD患者的病历，这些患者已接受了约10年的随访。从患者数据库中回顾性收集了各种社会人口统计学、临床和生化参数。参与者被分为正常体重、超重和肥胖组。采用多变量回归分析进行建模，以每年估算的肾小球滤过率（eGFR）降低作为因变量，评估肥胖（BMI）对CKD进展的影响。
研究的患者大多处于CKD 3期，对照组的平均GFR为36.2 ml/min/1.73 m²，超重或肥胖患者为44.3 ml/min/1.73 m²。超重的CKD患者的基线舒张压和平均动脉血压显著高于正常体重患者（分别为p = 0.009和p = 0.014）。在随访中，超重（分别为p = 0.03、p = 0.005和p = 0.003）和肥胖（分别为p = 0.008、p = 0.022和p = 0.003）的CKD患者的收缩压、舒张压和平均动脉血压显著高于正常体重患者。肥胖患者的平均随访甘油三酯水平显著高于正常体重患者（p = 0.042）。基于每年eGFR下降（>1 ml/min/1.73 m²/年）的CKD进展频率，超重患者为62.5%，肥胖患者为79.5%，而正常体重CKD患者为44.7%（p = 0.007）。然而，三组之间在进展速度（eGFR下降ml/min/1.73 m²/年）上未观察到显著差异。在多变量回归分析中，在调整了其他协变量（年龄、血压和蛋白尿）后，基线BMI是CKD进展（eGFR下降，ml/min/1.73 m²/年）的独立预测因素（R² = 0.122，p < 0.001）。观察期内BMI的百分比变化不影响eGFR下降速度。年轻也预示着CKD进展更快。
基于每年eGFR下降率，基线BMI和年轻与更快的CKD进展密切且独立相关。有必要进行前瞻性研究以探讨BMI与CKD及其并发症之间的关系。
