Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Obes Facts. 2011;4(3):238-43. doi: 10.1159/000329547. Epub 2011 Jun 6.
Epidemiological studies have shown that obesity is associated with chronic kidney disease and end stage renal disease. These studies have used creatinine derived equations to estimate glomerular filtration rate (GFR) and have indexed GFR to body surface area (BSA). However, the use of equations using creatinine as a surrogate marker of glomerular filtration and the indexation of GFR for BSA can be questioned in the obese population. First, these equations lack precision when they are compared to gold standard GFR measurements such as inulin clearances; secondly, the indexation of GFR for 1.73 m(2) of BSA leads to a systematic underestimation of GFR compared to absolute GFR in obese patients who have BSA that usually exceed 1.73 m(2). Obesity is also associated with pathophysiological changes that can affect the pharmacokinetics of drugs. The effect of obesity on both renal function and drug pharmacokinetics raises the issue of correct drug dosage in obese individuals. This may be particularly relevant for drugs known to have a narrow therapeutic range or excreted by the kidney.
流行病学研究表明，肥胖与慢性肾脏病和终末期肾病有关。这些研究使用肌酐衍生的公式来估计肾小球滤过率（GFR），并将 GFR 与体表面积（BSA）指数化。然而，在肥胖人群中，使用肌酐作为肾小球滤过的替代标志物的公式和将 GFR 指数化到 BSA 可能会受到质疑。首先，与金标准 GFR 测量（如菊粉清除率）相比，这些公式缺乏准确性；其次，将 GFR 指数化到 1.73 m2 的 BSA 会导致与肥胖患者的绝对 GFR 相比，GFR 系统低估，因为肥胖患者的 BSA 通常超过 1.73 m2。肥胖还与可能影响药物药代动力学的病理生理变化有关。肥胖对肾功能和药物药代动力学的影响提出了在肥胖个体中正确药物剂量的问题。对于已知治疗窗较窄或经肾脏排泄的药物，这可能尤为重要。
