Division of Nephrology, Second University of Naples, Naples, Italy.
Medical Statistics Unit, Second University of Naples, Naples, Italy.
Kidney Int. 2017 May;91(5):1224-1235. doi: 10.1016/j.kint.2016.12.013. Epub 2017 Feb 7.
Obesity and chronic kidney disease (CKD) are public health priorities that share core pathophysiological mechanisms. However, whether high body mass index (BMI) increases risk of CKD de novo remains ill-defined. To evaluate the role of BMI in predicting CKD onset in the general adult population, we performed a systematic review and meta-analysis of PubMed and ISI Web of Science databases articles published between January 2000 and August 2016 without language restriction. We selected studies in adult individuals from a general population with normal renal function at baseline that reported the risk of low estimated glomerular filtration (eGFR) (under 60 mL/min/1.73m) and/or albuminuria (1+ at dipstick or an albumin creatinine ratio of 3.4 mg/mmol or more) as hazard ratio, odds ratio or relative risk related to obesity, overweight, or BMI as continuous value. A total of 39 cohorts covering 630, 677 participants with a mean follow-up of 6.8 years were selected. Obesity increased the relative risk, 95% confidence interval and heterogeneity (I) of developing low eGFR (1.28, 1.07-1.54, [I: 95.0%]) and albuminuria (1.51, 1.36-1.67, [I: 62.7%]). Increase of BMI unit was also associated with higher risk of low eGFR (1.02, 1.01-1.03, [I: 24.3%]) and albuminuria (1.02, 1.00-1.04, [I: 0%]). Conversely, overweight did not predict onset of either low eGFR (1.06, 0.94-1.21, [I: 50.0%]) or albuminuria (1.24, 0.98-1.58, [I: 49.4%]). Thus, a high BMI predicts onset of albuminuria without kidney failure (CKD stages 1-2) as well as CKD stages 3 and higher, the effect being significant only in obese individuals. Hence, our findings may have implications to improve risk stratification and recommendations on body weight control in the general population.
肥胖症和慢性肾脏病（CKD）是公共卫生的重点，它们具有共同的核心病理生理学机制。然而，高体重指数（BMI）是否会增加新发 CKD 的风险仍不明确。为了评估 BMI 在预测普通成年人群 CKD 发病中的作用，我们对 2000 年 1 月至 2016 年 8 月期间发表的来自 PubMed 和 ISI Web of Science 数据库的文章进行了系统评价和荟萃分析，未对语言进行限制。我们选择了在基线时肾功能正常的普通人群中的成年人研究，报告了低估计肾小球滤过率（eGFR）（低于 60mL/min/1.73m）和/或白蛋白尿（1+干化学法或白蛋白肌酐比值为 3.4mg/mmol 或更高）的风险，肥胖、超重或 BMI 作为连续值的危险比、优势比或相对风险。共纳入 39 项队列研究，共 630677 名参与者，平均随访时间为 6.8 年。肥胖症增加了发展为低 eGFR（1.28，1.07-1.54，[I：95.0%]）和白蛋白尿（1.51，1.36-1.67，[I：62.7%]）的相对风险、95%置信区间和异质性（I）。BMI 每增加一个单位也与较低的 eGFR 风险增加相关（1.02，1.01-1.03，[I：24.3%]）和白蛋白尿（1.02，1.00-1.04，[I：0%]）。相反，超重并不能预测低 eGFR（1.06，0.94-1.21，[I：50.0%]）或白蛋白尿（1.24，0.98-1.58，[I：49.4%]）的发病。因此，高 BMI 不仅预测无肾衰竭的白蛋白尿（CKD 1-2 期），而且预测 CKD 3 期及更高阶段，该作用仅在肥胖个体中具有显著性。因此，我们的研究结果可能对改善普通人群的风险分层和体重控制建议具有重要意义。
