Abstract
BackgroundObesity is a risk factor for end-stage renal disease. Renal hyperfiltration, defined as an abnormally high glomerular filtration rate (GFR), is a link in the causal chain between diabetes and chronic kidney disease. Whether obesity is associated with hyperfiltration in the non-diabetic general population, remains unresolved due to a lack of consensus regarding the definition of hyperfiltration and the limited precision of high-range GFR estimations with creatinine and/or cystatin C.Methods1555 middle-aged participants without diabetes, renal or cardiovascular disease were enrolled from the general population in the Renal Iohexol Clearance Survey from the 6th Tromsø Study (RENIS-T6) between 2007 and 2009. Obesity was assessed using the body mass index (BMI), waist circumference (WC) and the waist-hip ratio (WHR). GFR was measured by iohexol clearance. Dichotomous variables for hyperfiltration were based on two alternative definitions using unadjusted GFR (mL/min) above the 90th percentile. The 90th percentile was age-, sex- and height-specific in one definition and age-, sex-, height- and weight-specific in the other.ResultsIn multivariable adjusted logistic regression models, only WHR was consistently associated with hyperfiltration based on both definitions. For the definition based on the age-, sex-, height- and weight-specific 90th percentile, the association with the WHR (odds ratios (95 % confidence intervals)) for hyperfiltration was 1.48 (1.08–2.02) per 0.10 WHR increase.ConclusionsCentral obesity is associated with hyperfiltration in the general population. The WHR may serve as a better indicator of the renal effects of obesity than BMI or WC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0386-4) contains supplementary material, which is available to authorized users.
Highlights
Obesity is a risk factor for end-stage renal disease
Most previous Renal hyperfiltration (RHF) studies with measured GFR (mGFR) have found a positive relationship between body mass index (BMI) and RHF that disappears upon the adjustment of glomerular filtration rate (GFR) to body surface area (BSA) [17,18,19,20]
Kwakernaak et al found that the waist-hip ratio (WHR) predicted a lower BSA-adjusted mGFR when adjusted for BMI, age, sex and blood pressure (BP) [18]
Summary
Renal hyperfiltration, defined as an abnormally high glomerular filtration rate (GFR), is a link in the causal chain between diabetes and chronic kidney disease. Obesity is a well-known risk factor for cardiovascular disease, hypertension and diabetes [2, 3]. These diseases are, in turn, well-established risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD) [4,5,6,7]. Renal hyperfiltration (RHF), or an abnormally high glomerular filtration rate (GFR), has been postulated to represent an early stage in the development of CKD [10], most clearly observed in diabetic nephropathy [11].
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