Abstract
Obesity causes modifications in the kidneys reversed by weight loss in adults. There is little data on renal function and effects of weight loss in children with obesity. The aim of this prospective study was to examine renal function and effect of a lifestyle intervention in children with overweight, obesity and morbid obesity. Two hundred forty-five children (age 12.4 ± 3.3 years, 40% boys, BMI z-score 3.46 ± 0.70) participating in an out-patient lifestyle intervention were included. Children with at least 12 months follow-up (n = 144 (58.8%)) were included in the longitudinal study. Anthropometry, blood analysis and blood pressure measurements were performed at baseline and follow-up. Glomerular filtration rate (GFR) was estimated using the Schwartz and FAS equation. eGFR was de-indexed using body surface area. Different cut-off points for defining glomerular hyperfiltration were used for stratification. Depending on the definition and equation used, glomerular hyperfiltration was present in 2% to 18% of the participants. After intervention, de-indexed eGFR decreased significantly in children with baseline glomerular hyperfiltration, depending on the eGFR equation and definition for glomerular hyperfiltration used. No associations of changes in eGFR with changes in BMI z-score, blood pressure or parameters of glucose and lipid metabolism were found. In conclusion, after one year of lifestyle intervention, eGFR decreases in hyperfiltrating children and adolescents with overweight, obesity and morbid obesity. eGFR and changes over time in children with obesity depend on eGFR equation used and on de-indexing for body surface area.
Highlights
Obesity is known to be an independent risk factor for the development of chronic kidney disease[1,2]
De-indexed eGFR-Schwartz was correlated in the same manner as de-indexed eGFR-FAS with only minor differences in correlation coefficients
To the best of our knowledge, this prospective study is the first to evaluate the effect of a multidisciplinary lifestyle intervention on renal function in children and adolescents with overweight, obesity and morbid obesity without a history of renal disease
Summary
Obesity is known to be an independent risk factor for the development of chronic kidney disease[1,2]. Glomerular hyperfiltration has been found to be an independent risk factor for all-cause mortality in an apparently healthy population[6]. In adults with obesity and chronic kidney disease weight loss improves proteinuria, albuminuria and normalizes the GFR7. Despite extensive research on the effects of weight loss on renal function in adults with obesity, to the best of our knowledge, no research has investigated these effects in children. We conducted a prospective study to assess the effect of one year of interdisciplinary lifestyle intervention on renal function in children with overweight, obesity and morbid obesity and the intermediary role of anthropometric changes and cardiovascular risk markers
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