ORIGINAL ARTICLE
63.
64.
65.
66.
67.
equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763–773 Delanaye P, Mariat C, Maillard N et al. Are the creatinine-based equations accurate to estimate glomerular filtration rate in African American populations? Clin J Am Soc Nephrol 2011; 6: 906–912 Flamant M, Haymann JP, Vidal-Petiot E et al. GFR Estimation using the Cockcroft-Gault, MDRD study, and CKD-EPI equations in the elderly. Am J Kidney Dis 2012; 60: 847–849 Schaeffner ES, Ebert N, Delanaye P et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012; 157: 471–481 Macdonald J, Marcora S, Jibani M et al. GFR Estimation using cystatin C is not independent of body composition. Am J Kidney Dis 2006; 48: 712–719 Seronie-Vivien S, Delanaye P, Pieroni L et al. Cystatin C: current position and future prospects. Clin Chem Lab Med 2008; 46: 1664–1686
Received for publication: 13.2.2013; Accepted in revised form: 25.6.2013
Nephrol Dial Transplant (2013) 28 (Suppl. 4): iv130–iv135 doi: 10.1093/ndt/gft072
Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel Eytan Cohen1,2,5*, Abigail Fraser3, 1,5
Elad Goldberg , Gai Milo4,5, Moshe Garty1,2,5 and Ilan Krause
1,5
1
Department of Medicine F—Recanati, Rabin Medical Center,
Campus Beilinson, Petah Tiqwa, Israel, 2
Clinical Pharmacology Unit, Rabin Medical Center, Campus
Beilinson, Petah Tiqwa, Israel, 3
MRC Centre for Causal Analyses in Translational Epidemiology,
School of Social and Community Medicine, University of Bristol, Bristol, UK, 4
Nephrology institute, Rabin Medical Center, Campus Beilinson,
Petah Tiqwa, Israel and 5
Correspondence and offprint requests to: Eytan Cohen; E-mail: [email protected]
A B S T R AC T Background. Any association between the body mass index (BMI) and chronic kidney disease (CKD) has so far © The Author 2013. Published by Oxford University Press on behalf of ERAEDTA. All rights reserved.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Keywords: CKD-EPI equation, body mass index, chronic kidney disease, gender
proved inconclusive. Most studies have estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. This has recently been replaced by the more accurate Chronic
iv130
Downloaded from http://ndt.oxfordjournals.org/ at University of Alabama at Birmingham on July 20, 2015
56. Chagnac A, Weinstein T, Korzets A et al. Glomerular hemodynamics in severe obesity. Am J Physiol Renal Physiol 2000; 278: F817–F822 57. Chagnac A, Weinstein T, Herman M et al. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol 2003; 14: 1480–1486 58. Ditzel J, Vestergaard P, Brinklov M. Glomerular filtration rate determined by 51 Cr-EDTA-complex. A practical method based upon the plasma disappearance curve determined from four plasma samples. Scand J Urol Nephrol 1972; 6: 166–170 59. Hagstam KE, Nordenfelt I, Svensson L et al. Comparison of different methods for determination of glomerular filtration rate in renal disease. Scand J Clin Lab Invest 1974; 34: 31–36 60. Medeiros FS, Sapienza MT, Prado ES et al. Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients: comparison with inulin renal clearance. Transpl Int 2009; 22: 323–331 61. Delanaye P, Cavalier E, Froissart M et al. Reproducibility of GFR measured by chromium-51-EDTA and iohexol. Nephrol Dial Transplant 2008; 23: 4077–4078 62. Froissart M, Rossert J, Jacquot C et al. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault
Overweight and obesity have become global epidemics [1], and it has been suggested that they can lead to impaired kidney function. Previous studies have shown an inconclusive association between overweight/obesity and chronic kidney disease (CKD). Some cross-sectional studies have demonstrated a positive relationship between the body mass index (BMI) and CKD [2–5], whereas other longitudinal studies yielded conflicting results. Some showed that a higher baseline BMI can predict future renal dysfuncion [6–10], while very recent studies showed no such association in both non-diabetic and diabetic patients [11–13]. No gender differences were found in the above-mentioned studies apart from two, one from Singapore and the other from Japan. These found a positive relationship between the BMI and CKD in men but not in women [4, 9]. These gender differences were explained by the large difference in smoking behaviour between men and women in South Asia. Glomerular filtration rate (GFR) is considered the best measure of overall kidney function in health and disease. The normal level of GFR varies according to age, sex and body size [14, 15]. The normal GFR in young adults is between 120 and 130 mL/min/1.73 m2 and declines with age. A GFR level 35 kg/m2. Conclusions. Our study is the first to suggest that morbid obesity may be an independent factor related to CKD in women.
higher mean BMI (P < 0.001 for all). In contrast, their levels of high-density lipoprotein (HDL) cholesterol were significantly lower (P < 0.001; Table 1). For both men and women, there was a positive association between the BMI category and the percentage of hypertension, diabetes mellitus and triglycerides levels. An inverse association was found between the BMI category and HDL cholesterol (linear P < 0.001 for all; Table 2). An association between the BMI category and the percentage of smokers was found only in women (P = 0.85 and 0.04 for men and women, respectively).
One hundred and sixty-seven men and 45 women had CKD, constituting 1.0% of the study population. Subjects with a BMI of 25–29.9 kg/m2, compared with subjects with a BMI 35 kg/m2, the ORs rose to 2.7 (1.3–5.5) and 15.4 (6.4–36.7) for men and women, respectively. These associations were attenuated in men after age adjustment and further after
Table 1: Characteristics of the study population P value
Age in years (mean, SD)
46.3 (10.6)
Hypertension (%)
11.8
6.3
63.
64.
65.
66.
67.
equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763–773 Delanaye P, Mariat C, Maillard N et al. Are the creatinine-based equations accurate to estimate glomerular filtration rate in African American populations? Clin J Am Soc Nephrol 2011; 6: 906–912 Flamant M, Haymann JP, Vidal-Petiot E et al. GFR Estimation using the Cockcroft-Gault, MDRD study, and CKD-EPI equations in the elderly. Am J Kidney Dis 2012; 60: 847–849 Schaeffner ES, Ebert N, Delanaye P et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012; 157: 471–481 Macdonald J, Marcora S, Jibani M et al. GFR Estimation using cystatin C is not independent of body composition. Am J Kidney Dis 2006; 48: 712–719 Seronie-Vivien S, Delanaye P, Pieroni L et al. Cystatin C: current position and future prospects. Clin Chem Lab Med 2008; 46: 1664–1686
Received for publication: 13.2.2013; Accepted in revised form: 25.6.2013
Nephrol Dial Transplant (2013) 28 (Suppl. 4): iv130–iv135 doi: 10.1093/ndt/gft072
Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel Eytan Cohen1,2,5*, Abigail Fraser3, 1,5
Elad Goldberg , Gai Milo4,5, Moshe Garty1,2,5 and Ilan Krause
1,5
1
Department of Medicine F—Recanati, Rabin Medical Center,
Campus Beilinson, Petah Tiqwa, Israel, 2
Clinical Pharmacology Unit, Rabin Medical Center, Campus
Beilinson, Petah Tiqwa, Israel, 3
MRC Centre for Causal Analyses in Translational Epidemiology,
School of Social and Community Medicine, University of Bristol, Bristol, UK, 4
Nephrology institute, Rabin Medical Center, Campus Beilinson,
Petah Tiqwa, Israel and 5
Correspondence and offprint requests to: Eytan Cohen; E-mail: [email protected]
A B S T R AC T Background. Any association between the body mass index (BMI) and chronic kidney disease (CKD) has so far © The Author 2013. Published by Oxford University Press on behalf of ERAEDTA. All rights reserved.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Keywords: CKD-EPI equation, body mass index, chronic kidney disease, gender
proved inconclusive. Most studies have estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. This has recently been replaced by the more accurate Chronic
iv130
Downloaded from http://ndt.oxfordjournals.org/ at University of Alabama at Birmingham on July 20, 2015
56. Chagnac A, Weinstein T, Korzets A et al. Glomerular hemodynamics in severe obesity. Am J Physiol Renal Physiol 2000; 278: F817–F822 57. Chagnac A, Weinstein T, Herman M et al. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol 2003; 14: 1480–1486 58. Ditzel J, Vestergaard P, Brinklov M. Glomerular filtration rate determined by 51 Cr-EDTA-complex. A practical method based upon the plasma disappearance curve determined from four plasma samples. Scand J Urol Nephrol 1972; 6: 166–170 59. Hagstam KE, Nordenfelt I, Svensson L et al. Comparison of different methods for determination of glomerular filtration rate in renal disease. Scand J Clin Lab Invest 1974; 34: 31–36 60. Medeiros FS, Sapienza MT, Prado ES et al. Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients: comparison with inulin renal clearance. Transpl Int 2009; 22: 323–331 61. Delanaye P, Cavalier E, Froissart M et al. Reproducibility of GFR measured by chromium-51-EDTA and iohexol. Nephrol Dial Transplant 2008; 23: 4077–4078 62. Froissart M, Rossert J, Jacquot C et al. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault
Overweight and obesity have become global epidemics [1], and it has been suggested that they can lead to impaired kidney function. Previous studies have shown an inconclusive association between overweight/obesity and chronic kidney disease (CKD). Some cross-sectional studies have demonstrated a positive relationship between the body mass index (BMI) and CKD [2–5], whereas other longitudinal studies yielded conflicting results. Some showed that a higher baseline BMI can predict future renal dysfuncion [6–10], while very recent studies showed no such association in both non-diabetic and diabetic patients [11–13]. No gender differences were found in the above-mentioned studies apart from two, one from Singapore and the other from Japan. These found a positive relationship between the BMI and CKD in men but not in women [4, 9]. These gender differences were explained by the large difference in smoking behaviour between men and women in South Asia. Glomerular filtration rate (GFR) is considered the best measure of overall kidney function in health and disease. The normal level of GFR varies according to age, sex and body size [14, 15]. The normal GFR in young adults is between 120 and 130 mL/min/1.73 m2 and declines with age. A GFR level 35 kg/m2. Conclusions. Our study is the first to suggest that morbid obesity may be an independent factor related to CKD in women.
higher mean BMI (P < 0.001 for all). In contrast, their levels of high-density lipoprotein (HDL) cholesterol were significantly lower (P < 0.001; Table 1). For both men and women, there was a positive association between the BMI category and the percentage of hypertension, diabetes mellitus and triglycerides levels. An inverse association was found between the BMI category and HDL cholesterol (linear P < 0.001 for all; Table 2). An association between the BMI category and the percentage of smokers was found only in women (P = 0.85 and 0.04 for men and women, respectively).
One hundred and sixty-seven men and 45 women had CKD, constituting 1.0% of the study population. Subjects with a BMI of 25–29.9 kg/m2, compared with subjects with a BMI 35 kg/m2, the ORs rose to 2.7 (1.3–5.5) and 15.4 (6.4–36.7) for men and women, respectively. These associations were attenuated in men after age adjustment and further after
Table 1: Characteristics of the study population P value
Age in years (mean, SD)
46.3 (10.6)
Hypertension (%)
11.8
6.3
