Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy.
Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy.
J Ren Nutr. 2020 May;30(3):261-267. doi: 10.1053/j.jrn.2019.07.003. Epub 2019 Sep 6.
RATIONALE & OBJECTIVE: The objective of this study is to evaluate the effect of body mass index (BMI) on estimated glomerular filtration rate (eGFR) levels in children with congenital solitary kidney (CSK). Moreover, we evaluated if other factors could influence this relationship.
Multicenter cross-sectional study.
SETTING & PARTICIPANTS: University hospital pediatrics departments.
Two hundred eighty-one patients with CSK.
Weight, height, BMI-SDS (standard deviation score), duration of overweight/obesity, pubertal stage, systolic (SBP) and diastolic (DBP) blood pressure, eGFR, and renal ultrasound were obtained at the last follow-up visit. The population was classified on the basis of nutritional status and divided in tertiles for duration of overweight/obesity. We compared eGFR levels among these categories. A simple regression was used to correlate eGFR with BMI-SDS. To evaluate if other factors could influence the relationship between eGFR and BMI-SDS, a general linear model was performed, including gender, birth weight<2.5 kg, age, BMI-SDS, SBP-SDS, DBP-SDS, RL-SDS (renal length), and presence of kidney injury at last follow-up as covariates.
The eGFR levels reduced gradually from underweight to obese patients (P = .047). The eGFR levels significantly increased across first and second tertiles of duration of overweight/obesity while they decreased across second and third tertiles of duration of overweight/obesity (P = .005). The eGFR and BMI-SDS at last follow-up were indirectly correlated (coefficient = -0.30, r = 9.2%, P = .0004). A general linear model for eGFR variance (model R = 26.37%; P = .02) confirmed an indirect and significant association of eGFR values with BMI-SDS as the only significant finding.
In patients with CSK, the higher the BMI-SDS and the duration of overweight/obesity, the lower the eGFR levels. Primary prevention strategies to counteract overweight/obesity are mandatory in CSK patients.
本研究旨在评估体重指数（BMI）对先天性孤立肾（CSK）患儿估算肾小球滤过率（eGFR）水平的影响。此外，我们还评估了其他因素是否会影响这种关系。
多中心横断面研究。
大学医院儿科部门。
281 例 CSK 患者。
在最后一次随访时，获得体重、身高、BMI-SDS（标准差评分）、超重/肥胖持续时间、青春期阶段、收缩压（SBP）和舒张压（DBP）、eGFR 和肾脏超声等指标。根据营养状况对人群进行分类，并根据超重/肥胖持续时间将其分为三分位数。我们比较了这些类别中的 eGFR 水平。采用简单回归法将 eGFR 与 BMI-SDS 相关联。为了评估其他因素是否会影响 eGFR 与 BMI-SDS 之间的关系，我们进行了一般线性模型分析，包括性别、出生体重<2.5kg、年龄、BMI-SDS、SBP-SDS、DBP-SDS、RL-SDS（肾长）和最后一次随访时的肾脏损伤作为协变量。
从体重不足到肥胖患者，eGFR 水平逐渐降低（P=.047）。在超重/肥胖持续时间的第一和第二三分位数中，eGFR 水平显著升高，而在第二和第三三分位数中，eGFR 水平则降低（P=.005）。最后一次随访时的 eGFR 和 BMI-SDS 呈间接相关（系数=-0.30，r=9.2%，P=.0004）。eGFR 方差的一般线性模型（模型 R=26.37%；P=.02）证实了 eGFR 值与 BMI-SDS 之间存在间接且显著的关联，这是唯一显著的发现。
在 CSK 患者中，BMI-SDS 越高，超重/肥胖持续时间越长，eGFR 水平越低。CSK 患者必须采取初级预防策略来对抗超重/肥胖。
