Amy J Kogon1, Jennifer Roem2, Michael F Schneider2, Mark M Mitsnefes3, Babette S Zemel4, Bradley A Warady5, Susan L Furth6, Nancy M Rodig7. 1. Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA. kogona@chop.edu. 2. Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 4. Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. 5. Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA. 6. Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA. 7. Pediatrics, Division of Nephrology, Boston Children's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Obesity is prevalent among children with chronic kidney disease (CKD) and is associated with cardiovascular disease and reduced quality of life. Its relationship with pediatric CKD progression has not been described. METHODS: We evaluated relationships between both body mass index (BMI) category (normal, overweight, obese) and BMI z-score (BMIz) change on CKD progression among participants of the Chronic Kidney Disease in Children study. Kaplan-Meier survival curves and multivariable parametric failure time models depict the association of baseline BMI category on time to kidney replacement therapy (KRT). Additionally, the annualized percentage change in estimated glomerular filtration rate (eGFR) was modeled against concurrent change in BMIz using multivariable linear regression with generalized estimating equations which allowed for quantification of the effect of BMIz change on annualized eGFR change. RESULTS: Participants had median age of 10.9 years [IQR: 6.5, 14.6], median eGFR of 50 ml/1.73 m2 [IQR: 37, 64] and 63% were male. 160 (27%) of 600 children with non-glomerular and 77 (31%) of 247 children with glomerular CKD progressed to KRT over a median of 5 years [IQR: 2, 8]. Times to KRT were not significantly associated with baseline BMI category. Children with non-glomerular CKD who were obese experienced significant improvement in eGFR (+ 0.62%; 95% CI: + 0.17%, + 1.08%) for every 0.1 standard deviation concurrent decrease in BMI. In participants with glomerular CKD who were obese, BMIz change was not significantly associated with annualized eGFR change. CONCLUSION: Obesity may represent a target of intervention to improve kidney function in children with non-glomerular CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Obesity is prevalent among children with chronic kidney disease (CKD) and is associated with cardiovascular disease and reduced quality of life. Its relationship with pediatric CKD progression has not been described. METHODS: We evaluated relationships between both body mass index (BMI) category (normal, overweight, obese) and BMI z-score (BMIz) change on CKD progression among participants of the Chronic Kidney Disease in Children study. Kaplan-Meier survival curves and multivariable parametric failure time models depict the association of baseline BMI category on time to kidney replacement therapy (KRT). Additionally, the annualized percentage change in estimated glomerular filtration rate (eGFR) was modeled against concurrent change in BMIz using multivariable linear regression with generalized estimating equations which allowed for quantification of the effect of BMIz change on annualized eGFR change. RESULTS: Participants had median age of 10.9 years [IQR: 6.5, 14.6], median eGFR of 50 ml/1.73 m2 [IQR: 37, 64] and 63% were male. 160 (27%) of 600 children with non-glomerular and 77 (31%) of 247 children with glomerular CKD progressed to KRT over a median of 5 years [IQR: 2, 8]. Times to KRT were not significantly associated with baseline BMI category. Children with non-glomerular CKD who were obese experienced significant improvement in eGFR (+ 0.62%; 95% CI: + 0.17%, + 1.08%) for every 0.1 standard deviation concurrent decrease in BMI. In participants with glomerular CKD who were obese, BMIz change was not significantly associated with annualized eGFR change. CONCLUSION: Obesity may represent a target of intervention to improve kidney function in children with non-glomerular CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Amy C Wilson; Michael F Schneider; Christopher Cox; Larry A Greenbaum; Jeffrey Saland; Colin T White; Susan Furth; Bradley A Warady; Mark M Mitsnefes Journal: Clin J Am Soc Nephrol Date: 2011-10-06 Impact factor: 8.237
Authors: Maleeka Ladhani; Samantha Lade; Stephen I Alexander; Louise A Baur; Philip A Clayton; Stephen McDonald; Jonathan C Craig; Germaine Wong Journal: Pediatr Nephrol Date: 2017-03-30 Impact factor: 3.714
Authors: Amy J Kogon; Ji Young Kim; Nina Laney; Jerilynn Radcliffe; Stephen R Hooper; Susan L Furth; Erum A Hartung Journal: Pediatr Nephrol Date: 2019-05-02 Impact factor: 3.714
Authors: Amy J Kogon; Matthew B Matheson; Joseph T Flynn; Arlene C Gerson; Bradley A Warady; Susan L Furth; Stephen R Hooper Journal: J Pediatr Date: 2015-10-23 Impact factor: 4.406
Authors: Nancy M Rodig; Jennifer Roem; Michael F Schneider; Patricia W Seo-Mayer; Kimberly J Reidy; Frederick J Kaskel; Amy J Kogon; Susan L Furth; Bradley A Warady Journal: Pediatr Nephrol Date: 2021-01-21 Impact factor: 3.714