Skip to main content
SpringerLink
Log in

Metabolic abnormalities, but not obesity, contribute to the mildly reduced eGFR in middle-aged and elderly Chinese

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

The role of obesity as a determinant of kidney dysfunction has not reached an agreement and the underlying reason may be due to the heterogeneity of obese phenotypes. The aim of the study was to explore the associations of different obese phenotypes with the change of estimated glomerular filtration rate (eGFR) and the roles of obesity and metabolic abnormalities in this association.

Methods

eGFR was calculated in 8,586 participants (≥40 years old). eGFR 60–90 mL/min/1.73 m2 was defined as the mildly reduced eGFR. Multiple logistic regression analysis was used to determine odds ratios (ORs) for mildly reduced eGFR in the metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO) groups, using the metabolically healthy non-obese (MHNO) subjects as the reference group. Meanwhile, the associations of body mass index (BMI), waist circumference (WC) and metabolic abnormalities (including hypertension, hyperglycemia and dyslipidemia) with the risk of mildly reduced eGFR were also investigated.

Results

The proportion of MHNO, MHO, MANO and MAO subjects was 8.3, 17.1, 10.1 and 64.5 %, respectively. Increased ORs were observed in MANO (OR 1.51, P = 0.014) and MAO (OR 1.47, P = 0.015) groups, after adjusting for age, gender, smoking, drinking, BMI and WC. When further adjusting for metabolic abnormalities, MANO (OR 1.24, P = 0.247) and MAO (OR 1.17, P = 0.366) subjects would not present increased risk of mildly reduced eGFR any more. Oppositely, fasting insulin (OR 1.03, P < 0.001), hyperglycemia (OR 1.25, P = 0.002) and dyslipidemia (OR 1.25, P = 0.002), but not hypertension, BMI and WC, significantly increased the risk of mildly reduced eGFR.

Conclusions

Metabolic abnormalities, but not simple obesity, may contribute to the mildly reduced eGFR in middle-aged and elderly Chinese.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tomonaga Y, Risch L, Szucs TD, Ambuehl PM (2013) The prevalence of chronic kidney disease in a primary care setting: a swiss cross-sectional study. PLoS ONE 8:e67848

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Zhang L, Wang F, Wang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379:815–822

    Article  PubMed  Google Scholar 

  3. Chen YC, Su YC, Lee CC, Huang YS, Hwang SJ (2012) Chronic kidney disease itself is a causal risk factor for stroke beyond traditional cardiovascular risk factors: a nationwide cohort study in Taiwan. PLoS ONE 7:e36332

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Hallan SI, Matsushita K, Sang Y et al (2012) Age and association of kidney measures with mortality and end-stage renal disease. JAMA 308:2349–2360

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR et al (2013) Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 382:339–352

    Article  PubMed  Google Scholar 

  6. Hermans MM, Henry R, Dekker JM et al (2007) Estimated glomerular filtration rate and urinary albumin excretion are independently associated with greater arterial stiffness: the Hoorn Study. J Am Soc Nephrol 18:1942–1952

    Article  CAS  PubMed  Google Scholar 

  7. Henry RM, Kostense PJ, Bos G et al (2002) Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int 62:1402–1407

    Article  PubMed  Google Scholar 

  8. Roy SK, Cespedes A, Li D, Choi TY, Budoff MJ (2011) Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium. Vasc Health Risk Manag 7:719–724

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Natali A, Boldrini B, Baldi S et al (2013) Impact of mild to moderate reductions of glomerular filtration rate on coronary artery disease severity. Nutr Metab Cardiovasc Dis. doi:10.1016/j.numecd.2013.12.005

    PubMed  Google Scholar 

  10. White SL, Cass A, Atkins RC, Chadban SJ (2005) Chronic kidney disease in the general population. Adv Chronic Kidney Dis 12:5–13

    Article  CAS  PubMed  Google Scholar 

  11. Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O (2006) Obesity and risk for chronic renal failure. J Am Soc Nephrol 17:1695–1702

    Article  CAS  PubMed  Google Scholar 

  12. Chen S, Liu H, Liu X et al (2013) Central obesity, C-reactive protein and chronic kidney disease: a community-based cross-sectional study in southern china. Kidney Blood Press Res 37:392–401

    Article  CAS  PubMed  Google Scholar 

  13. Stępień M, Stępień A, Wlazeł RN et al (2013) Obesity indices and adipokines in non-diabetic obese patients with early stages of chronic kidney disease. Med Sci Monit 19:1063–1072

    Article  PubMed Central  PubMed  Google Scholar 

  14. Onat A, Hergenç G, Uyarel H et al (2007) Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random nondiabetic population sample. Kidney Blood Press Res 30:88–96

    CAS  PubMed  Google Scholar 

  15. Ji B, Zhang S, Gong L et al (2013) The risk factors of mild decline in estimated glomerular filtration rate in a community-based population. Clin Biochem 46:750–754

    Article  CAS  PubMed  Google Scholar 

  16. Griffin KA, Kramer H, Bidani AK (2008) Adverse renal consequences of obesity. Am J Physiol Renal Physiol 294:F685–F696

    Article  CAS  PubMed  Google Scholar 

  17. McLaughlin T, Abbasi F, Lamendola C, Reaven G (2007) Heterogeneity in the prevalence of risk factors for cardiovascular disease and type 2 diabetes mellitus in obese individuals: effect of differences in insulin sensitivity. Arch Intern Med 167:642–648

    Article  CAS  PubMed  Google Scholar 

  18. Phillips CM (2013) Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord 14:219–227

    Article  CAS  PubMed  Google Scholar 

  19. Ning G; Reaction Study Group (2012) Risk evaluation of cancers in Chinese diabetic individuals: a longitudinal (reaction) study. J Diabetes 4:172–173

    Article  Google Scholar 

  20. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sung KC, Cha SC, Sung JW, So MS, Byrne CD (2014) Metabolically healthy obese subjects are at risk of fatty liver but not of pre-clinical atherosclerosis. Nutr Metab Cardiovasc Dis 24:256–262

    Article  PubMed  Google Scholar 

  22. Expert Panel on Metabolic Syndrome of Chinese Diabetes Society (2004) Recommendations on metabolic syndrome of Chinese diabetes society. Chin J Diab 12:156–161

    Google Scholar 

  23. Ruderman NB, Schneider SH, Berchtold P (1981) The “metabolically-obese,” normal-weight individual. Am J Clin Nutr 34:1617–1621

    CAS  PubMed  Google Scholar 

  24. Sesti G, Succurro E, Arturi F et al (2011) IGF-1 levels link estimated glomerular filtration rate to insulin resistance in obesity: a study in obese, but metabolically healthy, subjects and obese, insulin-resistant subjects. Nutr Metab Cardiovasc Dis 21:933–940

    Article  CAS  PubMed  Google Scholar 

  25. Pyram R, Kansara A, Banerji MA, Loney-Hutchinson L (2012) Chronic kidney disease and diabetes. Maturitas 71:94–103

    Article  CAS  PubMed  Google Scholar 

  26. Chen W, Wang H, Dong X et al (2009) Prevalence and risk factors associated with chronic kidney disease in an adult population from southern China. Nephrol Dial Transplant 24:1205–1212

    Article  PubMed Central  PubMed  Google Scholar 

  27. Collins AJ, Foley RN, Herzog C et al (2011) US renal data system 2010 annual data report. Am J Kidney Dis 57(A8):e1–e526

    Google Scholar 

  28. Palatini P, Dorigatti F, Saladini F et al (2012) Factors associated with glomerular hyperfiltration in the early stage of hypertension. Am J Hypertens 25:1011–1016

    Article  CAS  PubMed  Google Scholar 

  29. Jessani S, Levey AS, Bux R et al (2014) Estimation of GFR in South Asians: a study from the general population in Pakistan. Am J Kidney Dis 63:49–58

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the Chinese Society of Endocrinology, the National Natural Science Foundation of China (No. 81100617), the Medical and Health Science and Technology Development Projects of Shandong Province (2011HD005), the National Science and Technology Support Plan (2009BAI80B04), the Natural Science Foundation of Shandong Province (ZR2012HM014), the International Science and Technology Projects of Shandong Province (2012GGE27126), the Business Plan of Jinan Students Studying Abroad (20110407), the Outstanding Young Scientist Research Award Foundation of Shandong Province (2013BSE27128) and the special scientific research fund of clinical medicine of Chinese Medical Association (12030420342).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China

    Chuan Wang, Kai Liang, Yu Sun, Jun Song, Peng Lin, Lei Gong, Meijian Wang, Fuqiang Liu, Wenjuan Li, Juan Xiao, Fei Yan, Junpeng Yang, Lingshu Wang, Meng Tian, Jidong Liu, Ruxing Zhao, Xinguo Hou & Li Chen

  2. Shantui Community Health Center, Jining, 272000, Shandong, China

    Xiuping Zhang

  3. Department of Endocrinology, Second People’s Hospital of Jining, Jining, 272049, Shandong, China

    Chengqiao Li

  4. Lukang Hospital of Jining, Jining, 272141, Shandong, China

    Weifang Yang

  5. China National Heavy Duty Truck Group Corporation Hospital, Jinan, 250116, Shandong, China

    Zeqiang Ma

Authors
  1. Chuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiuping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chengqiao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Weifang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeqiang Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yu Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peng Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lei Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Meijian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Fuqiang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Wenjuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Juan Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Fei Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Junpeng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Lingshu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Meng Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Jidong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ruxing Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Xinguo Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Li Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Xinguo Hou or Li Chen.

Additional information

Chuan Wang and Kai Liang have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, C., Liang, K., Zhang, X. et al. Metabolic abnormalities, but not obesity, contribute to the mildly reduced eGFR in middle-aged and elderly Chinese. Int Urol Nephrol 46, 1793–1799 (2014). https://doi.org/10.1007/s11255-014-0797-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-014-0797-8

Keywords

Search

Navigation