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- Title
Obesity, Hyperfiltration, and Early Kidney Damage: A New Formula for the Estimation of Creatinine Clearance.
- Authors
Basolo, Alessio; Salvetti, Guido; Giannese, Domenico; Genzano, Susanna Bechi; Ceccarini, Giovanni; Giannini, Riccardo; Sotgia, Gianluca; Fierabracci, Paola; Piaggi, Paolo; Santini, Ferruccio
- Abstract
Context: 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. Objective: The performance of prediction formulas was compared with 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: 53 + 0.7 X (140 - Age) x Weight/(96xSCr) x (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. Conclusion: 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.
- Subjects
OBESITY; CREATININE; KIDNEY diseases
- Publication
Journal of Clinical Endocrinology & Metabolism, 2023, Vol 108, Issue 12, p3280
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgad330