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Association between obesity and glomerular hyperfiltration: the confounding effect of smoking and sodium and protein intakes

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Abstract

Purpose

Glomerular hyperfiltration has been suggested as a possible mechanism linking obesity and chronic kidney disease (CKD), independently of classical risk factors. We explored the association of overweight and obesity with glomerular hyperfiltration in a large sample of the Swiss adult population, accounting for several confounders including dietary factors.

Methods

Data from a 2010 to 2012 cross-sectional population-based survey in Switzerland were used. Creatinine clearance (CrCl) was determined from 24-h urine collection; CrCl > 140 ml/min was used to define glomerular hyperfiltration. Participants were categorized into lean (<25 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2) according to body mass index (BMI).

Results

A total of 1339 participants were included in the analysis [median (IQR) age 49.4 (34.3–63.5) years, 48.9 % men]. The prevalences of overweight and obesity were 32.2 and 14.2 %, respectively. Median CrCl was 102[84–121] ml/min in lean, 110 [87–136] ml/min in overweight and 124 [97–150] ml/min in obese participants (p < 0.001). The prevalence of glomerular hyperfiltration increased across BMI categories (10.4, 20.8 and 34.7 %, respectively; p < 0.001). This positive association remained significant after adjusting for age, sex, hypertension, diabetes, smoking and dietary factors (sodium and protein intakes): odds ratio [95 %CI] 2.39 [1.52–3.76] (p < 0.001) for overweight versus lean and 4.10[2.31–7.27] (p < 0.001) for obesity versus lean.

Conclusions

BMI categories and glomerular hyperfiltration are positively associated, independently of other known CKD risk factors and dietary confounders, suggesting that glomerular hyperfiltration may represent an early renal phenotype in obesity. Our observations confirm the significant association of glomerular hyperfiltration with sodium and protein intakes and identify sodium intake as an important modifying factor of the association between hyperfiltration and obesity.

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Acknowledgments

The study was funded mainly by the Swiss Federal Office of Public Health (Contracts number 09.004165/404.0101/-2 and 09.005791/414.0000/-74). A contribution by the Swiss Society of Hypertension had also been received. The Nephrology Division and the Institute of Social and Preventive Medicine of Lausanne University Hospital provided further logistic and analytical support. GWR is supported by grants from the SNF Ambizione PZ00P3_121656 and PZ00P3_13262.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The Swiss Survey on Salt complied with the Declaration of Helsinki and was approved by the local Institutional Ethics Committees of each participating center. All participants gave written informed consent.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Nephrology, Locarno Hospital, 6600, Locarno, Switzerland

    Adam Ogna

  2. Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland

    Valentina Forni Ogna, Michel Burnier & Gregoire Wuerzner

  3. Community Prevention Unit, University Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland

    Murielle Bochud, Idris Guessous & Fred Paccaud

  4. Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland

    Idris Guessous

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  1. Adam Ogna
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  2. Valentina Forni Ogna
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  6. Michel Burnier
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  7. Gregoire Wuerzner
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Corresponding author

Correspondence to Adam Ogna.

Additional information

On behalf of the Swiss Survey on Salt Group.

Swiss Survey on Salt Group members are Conen D. (Basel), Hayoz D. (Fribourg), Péchère-Bertschi A. (Genève), Erne P. (Luzern), Binet I. (St-Gallen), Muggli F. (Ticino), Gallino A. (Ticino), Gabutti L. (Ticino) and Suter P.M. (Zürich).

Adam Ogna and Valentina Forni Ogna are joint first authors.

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Ogna, A., Forni Ogna, V., Bochud, M. et al. Association between obesity and glomerular hyperfiltration: the confounding effect of smoking and sodium and protein intakes. Eur J Nutr 55, 1089–1097 (2016). https://doi.org/10.1007/s00394-015-0923-0

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  • DOI: https://doi.org/10.1007/s00394-015-0923-0

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