Objective: Glomerular hyperfiltration may represent a direct pathogenetic link between obesity and kidney disease. The most widely used methods to estimate creatine clearance such as Cockroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) have not been validated in subjects with obesity. The performance of prediction formulas was compared to measured creatinine clearance (mCrCl) in subjects with obesity. Methods: The study population included 342 patients with obesity (mean BMI 47.6 kg/m2) without primary kidney disease. A urine collection was performed over 24 hours for measurement of CrCl. Results: mCrCl increased with body weight. The CG formula showed an overestimation at high CrCl, whereas an underestimation resulted from CKD-EPI and MDRD. To improve the accuracy of estimated CrCl (eCrCl), a new CG-based formula was developed as follow: 53+0.7 × (140-Age) × Weight/(96xSCr) × (0.85 if female)A cut-off point for BMI of 32 Kg/m2 was identified, at which the new formula may be applied to improve eCrCl. Conclusions: In patients with obesity the glomerular filtration rate increases with body weight, and it is associated with the presence of albuminuria, suggesting an early kidney injury. We propose a novel formula that improves the accuracy of eCrCl to avoid missed diagnoses of hyperfiltration in patients with obesity.

Obesity, hyperfiltration and early kidney damage: a new formula for the estimation of creatinine clearance

Basolo, Alessio
;
Salvetti, Guido;Giannese, Domenico;Genzano, Susanna Bechi;Ceccarini, Giovanni;Giannini, Riccardo;Sotgia, Gianluca;Fierabracci, Paola;Piaggi, Paolo;Santini, Ferruccio
2023-01-01

Abstract

Objective: Glomerular hyperfiltration may represent a direct pathogenetic link between obesity and kidney disease. The most widely used methods to estimate creatine clearance such as Cockroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) have not been validated in subjects with obesity. The performance of prediction formulas was compared to measured creatinine clearance (mCrCl) in subjects with obesity. Methods: The study population included 342 patients with obesity (mean BMI 47.6 kg/m2) without primary kidney disease. A urine collection was performed over 24 hours for measurement of CrCl. Results: mCrCl increased with body weight. The CG formula showed an overestimation at high CrCl, whereas an underestimation resulted from CKD-EPI and MDRD. To improve the accuracy of estimated CrCl (eCrCl), a new CG-based formula was developed as follow: 53+0.7 × (140-Age) × Weight/(96xSCr) × (0.85 if female)A cut-off point for BMI of 32 Kg/m2 was identified, at which the new formula may be applied to improve eCrCl. Conclusions: In patients with obesity the glomerular filtration rate increases with body weight, and it is associated with the presence of albuminuria, suggesting an early kidney injury. We propose a novel formula that improves the accuracy of eCrCl to avoid missed diagnoses of hyperfiltration in patients with obesity.
2023
Basolo, Alessio; Salvetti, Guido; Giannese, Domenico; Genzano, Susanna Bechi; Ceccarini, Giovanni; Giannini, Riccardo; Sotgia, Gianluca; Fierabracci, Paola; Piaggi, Paolo; Santini, Ferruccio
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1181008
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