Ogna Adam, Forni Ogna Valentina, Bochud Murielle, Guessous Idris, Paccaud Fred, Burnier Michel, Wuerzner Gregoire
Department of Internal Medicine and Nephrology, Locarno Hospital, 6600, Locarno, Switzerland.
Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
Eur J Nutr. 2016 Apr;55(3):1089-97. doi: 10.1007/s00394-015-0923-0. Epub 2015 May 14.
Glomerular hyperfiltration has been suggested as a possible mechanism linking obesity and chronic kidney disease (CKD), independently of classical risk factors. We explored the association of overweight and obesity with glomerular hyperfiltration in a large sample of the Swiss adult population, accounting for several confounders including dietary factors.
Data from a 2010 to 2012 cross-sectional population-based survey in Switzerland were used. Creatinine clearance (CrCl) was determined from 24-h urine collection; CrCl > 140 ml/min was used to define glomerular hyperfiltration. Participants were categorized into lean (<25 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (≥30 kg/m(2)) according to body mass index (BMI).
A total of 1339 participants were included in the analysis [median (IQR) age 49.4 (34.3-63.5) years, 48.9 % men]. The prevalences of overweight and obesity were 32.2 and 14.2 %, respectively. Median CrCl was 102[84-121] ml/min in lean, 110 [87-136] ml/min in overweight and 124 [97-150] ml/min in obese participants (p < 0.001). The prevalence of glomerular hyperfiltration increased across BMI categories (10.4, 20.8 and 34.7 %, respectively; p < 0.001). This positive association remained significant after adjusting for age, sex, hypertension, diabetes, smoking and dietary factors (sodium and protein intakes): odds ratio [95 %CI] 2.39 [1.52-3.76] (p < 0.001) for overweight versus lean and 4.10[2.31-7.27] (p < 0.001) for obesity versus lean.
BMI categories and glomerular hyperfiltration are positively associated, independently of other known CKD risk factors and dietary confounders, suggesting that glomerular hyperfiltration may represent an early renal phenotype in obesity. Our observations confirm the significant association of glomerular hyperfiltration with sodium and protein intakes and identify sodium intake as an important modifying factor of the association between hyperfiltration and obesity.
肾小球高滤过被认为是一种将肥胖与慢性肾脏病（CKD）联系起来的可能机制，独立于经典危险因素。我们在瑞士成年人群的大样本中探讨了超重和肥胖与肾小球高滤过的关联，并考虑了包括饮食因素在内的几个混杂因素。
使用了2010年至2012年瑞士基于人群的横断面调查数据。通过收集24小时尿液来测定肌酐清除率（CrCl）；CrCl>140 ml/分钟用于定义肾小球高滤过。根据体重指数（BMI）将参与者分为消瘦（<25 kg/m²）、超重（25 - 29.9 kg/m²）和肥胖（≥30 kg/m²）。
共有1339名参与者纳入分析[年龄中位数（四分位间距）49.4（34.3 - 63.5）岁，男性占48.9%]。超重和肥胖的患病率分别为32.2%和14.2%。消瘦参与者的CrCl中位数为102[84 - 121]ml/分钟，超重者为110[87 - 136]ml/分钟，肥胖者为124[97 - 150]ml/分钟（p<0.001）。肾小球高滤过的患病率随BMI类别增加（分别为10.4%、20.8%和34.7%；p<0.001）。在调整年龄、性别、高血压、糖尿病、吸烟和饮食因素（钠和蛋白质摄入量）后，这种正相关仍然显著：超重与消瘦相比的优势比[95%置信区间]为2.39[1.52 - 3.76]（p<0.001），肥胖与消瘦相比为4.10[2.31 - 7.27]（p<0.001）。
BMI类别与肾小球高滤过呈正相关，独立于其他已知的CKD危险因素和饮食混杂因素，表明肾小球高滤过可能代表肥胖中的一种早期肾脏表型。我们的观察结果证实了肾小球高滤过与钠和蛋白质摄入量之间的显著关联，并确定钠摄入量是高滤过与肥胖之间关联的一个重要调节因素。
