Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Nephron. 2021;145(3):245-255. doi: 10.1159/000513869. Epub 2021 Mar 5.
BACKGROUND/AIMS: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized.
In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots.
The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001).
Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.
背景/目的：肥胖是心血管疾病的已知危险因素，可导致肾脏疾病的发生和进展。然而，肥胖对原发性肾小球疾病结局的具体影响尚未得到很好的描述。
在这项前瞻性队列研究中，数据来自于 2010 年至 2019 年期间在北美 23 个地点参加肾病综合征研究网络（NEPTUNE）的 541 名参与者，分析了血压、血脂以及包括完全蛋白尿缓解、肾衰竭和慢性肾脏病进展在内的肾脏疾病结局。使用广义估计方程的线性和逻辑回归以及 Kaplan-Meier 图的时变 Cox 回归分析数据。
成人基线肥胖的患病率为 43.3%（N=156），儿童为 37.6%（N=68）。在成年人中，肥胖与较高的收缩压（β=6.49，95%CI：2.41，10.56，p=0.002）、血脂异常（OR=1.74，95%CI：1.30，2.32，p<0.001）、甘油三酯（β=41.92，95%CI：17.12，66.71，p=0.001）和较低的高密度脂蛋白（β=-6.92，95%CI：-9.32，-4.51，p<0.001）呈纵向相关。在儿童中，随着时间的推移，肥胖与较高的收缩压指数（β=0.04，95%CI：0.02，0.06，p<0.001）和高血压（OR=1.43，95%CI：1.04，1.98，p=0.03）相关。在成人和儿童中，肥胖均与蛋白尿完全缓解的风险显著降低相关（成人 HR=0.80，95%CI：0.69，0.88，p<0.001；儿科 HR=0.72，95%CI：0.61，0.84，p<0.001）。
肥胖与成人和儿童蛋白尿性肾小球疾病患者的心血管风险升高和蛋白尿缓解率降低相关。在这一高危患者群体中，体重减轻策略可能会阻止心血管疾病和肾功能的进行性下降。
