Abstract
Glomerular hyperfiltration is recognized as an early marker of progressive kidney dysfunction in the obese population. This study aimed to identify the relationship between glomerular hyperfiltration and body fat distribution measured by computed tomography (CT) in healthy Korean adults. The study population included individuals aged 20–64 years who went a routine health check-up including an abdominal CT scan. We selected 4,378 individuals without diabetes and hypertension. Glomerular filtration rate was estimated using the CKD-EPI equation, and glomerular hyperfiltration was defined as the highest quintile of glomerular filtration rate. Abdominal adipose tissue areas were measured at the level of the umbilicus using a 16-detector CT scanner, and the cross-sectional area was calculated using Rapidia 2.8 CT software. The prevalence of glomerular hyperfiltration increased significantly according to the subcutaneous adipose tissue area in men (OR = 1.74 (1.16–2.61), P for trend 0.016, for the comparisons of lowest vs. highest quartile) and visceral adipose tissue area in women (OR = 2.34 (1.46–3.75), P for trend < 0.001) in multivariate analysis. After stratification by body mass index (normal < 23 kg/m2, overweight ≥ 23 kg/m2), male subjects with greater subcutaneous adipose tissue, even those in the normal BMI group, had a higher prevalence of glomerular hyperfiltration (OR = 2.11 (1.17–3.80), P for trend = 0.009). Among women, the significance of visceral adipose tissue area on glomerular hyperfiltration resulted from the normal BMI group (OR = 2.14 (1.31–3.49), P for trend = 0.002). After menopause, the odds ratio of the association of glomerular hyperfiltration with subcutaneous abdominal adipose tissue increased (OR = 2.96 (1.21–7.25), P for trend = 0.013). Subcutaneous adipose tissue areas and visceral adipose tissue areas are positively associated with glomerular hyperfiltration in healthy Korean adult men and women, respectively. In post-menopausal women, visceral adipose tissue area shows significant positive association with glomerular hyperfiltration as in men.
Highlights
Obesity is recognized as an independent risk factor for the development of chronic kidney disease and end-stage renal disease [1]
This study aimed to identify the relationship between glomerular hyperfiltration and body fat distribution measured by computed tomography (CT) in healthy Korean adults
glomerular filtration rate (GFR) was positively correlated with subcutaneous adipose tissue area (Fig 1A; P < 0.001, R2 = 0.014), and the association of subcutaneous adipose tissue with GFR was stronger than that of visceral adipose tissue area (R2 = 0.001)
Summary
Obesity is recognized as an independent risk factor for the development of chronic kidney disease and end-stage renal disease [1]. The risk of end-stage renal disease associated with obesity is almost comparable to that of hypertension [2]. In the pathogenesis of obesity-related kidney disease, glomerular hyperfiltration can be associated with enhanced intraglomerular pressure transmission and subsequent structural abnormality of glomerulomegaly, which is a histological hallmark of obesity-related glomerulopathy [8,9,10]. Glomerular hyperfiltration, which is observed before the appearance of glomerulomegaly or renal dysfunction, could be an early marker of obesity-related kidney disease, similar to the glomerular hyperfiltration that precedes the development of microalbuminuria in patients with hypertension or diabetes [11,12,13]
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