Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy.
Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy.
J Ren Nutr. 2018 Sep;28(5):359-362. doi: 10.1053/j.jrn.2018.01.001. Epub 2018 Feb 13.
We aimed to investigate which clinical and metabolic factors could influence the estimated glomerular filtration rate (eGFR) levels, evaluating a large population of obese children without suspect of primary kidney disease.
Retrospective, cross-sectional study.
Pediatric university department.
We enrolled 2,957 obese children and adolescents consecutively attending our department between January 2000 and 2017. Inclusion criteria were body mass index (BMI) > 95th percentile and eGFR > 90 mL/min/1.73 m. Exclusion criteria were secondary forms of obesity, eGFR < 90 mL/min/1.73 m, proteinuria/hematuria at urine dipstick, or consumption of any medication.
Weight, waist circumference, height, waist to height ratio (W/Hr), BMI-standard deviation score (SDS), pubertal stage, systolic blood pressure (SBP) and diastolic blood pressure (DBP), duration of obesity, insulin, eGFR, and homeostasis model assessment (HOMA-IR) were obtained. A general linear model was performed for a multiple variable analysis.
The population was divided in tertiles for BMI-SDS, W/Hr, SBP- and DBP-SDS, HOMA-IR, and duration of obesity. We compared eGFR levels among these tertiles.
The eGFR levels significantly increased across both BMI-SDS and W/Hr tertiles. Conversely the eGFR levels significantly decreased across SBP-SDS, HOMA-IR, and duration of obesity tertiles. No significant differences in eGFR levels across DBP-SDS tertiles were detected. Pubertal patients presented significantly lower eGFR values compared with prepubertal patients. A general linear model for eGFR variance including as covariates W/Hr, HOMA-IR, duration of obesity, pubertal stage, BMI-SDS, and SBP-SDS (model R 39.7%; model P < .00001) was performed. It confirmed a direct association of eGFR values with BMI-SDS and an indirect association with HOMA-IR, duration of obesity, pubertal stage, and SBP-SDS.
We showed a positive correlation of eGFR with both BMI-SDS and a negative one with SBP-SDS, HOMA-IR, pubertal stage, and duration of obesity. The duration of obesity was the variable most significantly associated to eGFR levels.
我们旨在探究哪些临床和代谢因素可能会影响肾小球滤过率估计值（eGFR）水平，并评估了一大批无原发性肾脏疾病可疑迹象的肥胖儿童。
回顾性、横断面研究。
儿科大学系。
我们连续纳入了 2000 年 1 月至 2017 年期间在我系就诊的 2957 名肥胖儿童和青少年。纳入标准为体重指数（BMI）>第 95 百分位数和 eGFR > 90 mL/min/1.73 m。排除标准为继发性肥胖、eGFR < 90 mL/min/1.73 m、尿试纸蛋白尿/血尿或服用任何药物。
测量体重、腰围、身高、腰高比（W/Hr）、BMI-标准差评分（BMI-SDS）、青春期阶段、收缩压（SBP）和舒张压（DBP）、肥胖持续时间、胰岛素、eGFR 和稳态模型评估（HOMA-IR）。进行多元线性模型分析。
根据 BMI-SDS、W/Hr、SBP-DBP SDS、HOMA-IR 和肥胖持续时间将人群分为三分位组。比较这些三分位组的 eGFR 水平。
eGFR 水平随 BMI-SDS 和 W/Hr 三分位组而显著升高。相反，eGFR 水平随 SBP-DBP SDS、HOMA-IR 和肥胖持续时间三分位组而显著降低。未发现 DBP-SDS 三分位组之间 eGFR 水平有显著差异。与青春期前患者相比，青春期患者的 eGFR 值显著降低。纳入 W/Hr、HOMA-IR、肥胖持续时间、青春期阶段、BMI-SDS 和 SBP-SDS 作为协变量的 eGFR 方差的一般线性模型（模型 R 39.7%；模型 P < 0.00001）。它证实了 eGFR 值与 BMI-SDS 呈正相关，与 HOMA-IR、肥胖持续时间、青春期阶段和 SBP-SDS 呈间接相关。
我们显示 eGFR 与 BMI-SDS 呈正相关，与 SBP-SDS、HOMA-IR、青春期阶段和肥胖持续时间呈负相关。肥胖持续时间是与 eGFR 水平最显著相关的变量。
