Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA.
Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2023 Apr;38(4):1257-1266. doi: 10.1007/s00467-022-05655-6. Epub 2022 Aug 26.
Obesity is prevalent among children with chronic kidney disease (CKD) and is associated with cardiovascular disease and reduced quality of life. Its relationship with pediatric CKD progression has not been described.
We evaluated relationships between both body mass index (BMI) category (normal, overweight, obese) and BMI z-score (BMIz) change on CKD progression among participants of the Chronic Kidney Disease in Children study. Kaplan-Meier survival curves and multivariable parametric failure time models depict the association of baseline BMI category on time to kidney replacement therapy (KRT). Additionally, the annualized percentage change in estimated glomerular filtration rate (eGFR) was modeled against concurrent change in BMIz using multivariable linear regression with generalized estimating equations which allowed for quantification of the effect of BMIz change on annualized eGFR change.
Participants had median age of 10.9 years [IQR: 6.5, 14.6], median eGFR of 50 ml/1.73 m [IQR: 37, 64] and 63% were male. 160 (27%) of 600 children with non-glomerular and 77 (31%) of 247 children with glomerular CKD progressed to KRT over a median of 5 years [IQR: 2, 8]. Times to KRT were not significantly associated with baseline BMI category. Children with non-glomerular CKD who were obese experienced significant improvement in eGFR (+ 0.62%; 95% CI: + 0.17%, + 1.08%) for every 0.1 standard deviation concurrent decrease in BMI. In participants with glomerular CKD who were obese, BMIz change was not significantly associated with annualized eGFR change.
Obesity may represent a target of intervention to improve kidney function in children with non-glomerular CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
肥胖在患有慢性肾脏病（CKD）的儿童中很常见，与心血管疾病和生活质量降低有关。但其与儿科 CKD 进展的关系尚未描述。
我们评估了慢性肾脏病儿童研究参与者的 BMI 类别（正常、超重、肥胖）和 BMI z 评分（BMIz）变化与 CKD 进展之间的关系。Kaplan-Meier 生存曲线和多变量参数失效时间模型描述了基线 BMI 类别与肾脏替代治疗（KRT）时间之间的关联。此外，使用具有广义估计方程的多变量线性回归模型，根据 BMIz 的同期变化，对估计肾小球滤过率（eGFR）的年化百分比变化进行建模，该模型允许量化 BMIz 变化对年化 eGFR 变化的影响。
参与者的中位年龄为 10.9 岁[IQR：6.5，14.6]，中位 eGFR 为 50 ml/1.73 m[IQR：37，64]，63%为男性。600 名非肾小球性 CKD 儿童中有 160 名（27%）和 247 名肾小球性 CKD 儿童中有 77 名（31%）在中位时间 5 年内进展为 KRT[IQR：2，8]。KRT 的时间与基线 BMI 类别没有显著关联。患有非肾小球性 CKD 的肥胖儿童，BMIz 每降低 0.1 个标准差，eGFR 就会显著提高（+0.62%；95%CI：+0.17%，+1.08%）。在肥胖的肾小球性 CKD 患者中，BMIz 变化与 eGFR 的年化变化无显著相关性。
肥胖可能是改善非肾小球性 CKD 儿童肾功能的干预目标。可提供图形摘要的更高分辨率版本作为补充信息。
