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.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

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体重指数 (BMI) 和 BMI 与儿童慢性肾脏病进展的关系

背景

肥胖在患有慢性肾脏病 (CKD) 的儿童中很普遍，并且与心血管疾病和生活质量下降有关。它与儿科 CKD 进展的关系尚未被描述。

方法

我们评估了儿童慢性肾脏病研究参与者的体重指数 (BMI) 类别（正常、超重、肥胖）和 BMI z 评分 (BMIz) 变化与 CKD 进展之间的关系。Kaplan-Meier 生存曲线和多变量参数失效时间模型描述了基线 BMI 类别按时与肾脏替代治疗 (KRT) 的关联。此外，估计肾小球滤过率 (eGFR) 的年化百分比变化是根据 BMIz 的并发变化建模的，使用多变量线性回归和广义估计方程，允许量化 BMIz 变化对年化 eGFR 变化的影响。

结果

参与者的中位年龄为 10.9 岁 [IQR: 6.5, 14.6]，中位 eGFR 为 50 ml/1.73 m ² [IQR: 37, 64]，63% 为男性。600 名非肾小球 CKD 儿童中的 160 名 (27%) 和 247 名肾小球 CKD 儿童中的 77 名 (31%) 在中位 5 年内进展为 KRT [IQR：2、8]。KRT 时间与基线 BMI 类别没有显着相关性。BMI 每降低 0.1 个标准差，肥胖的非肾小球 CKD 儿童的 eGFR 显着改善（+ 0.62%；95% CI：+ 0.17%，+ 1.08%）。在肥胖的肾小球 CKD 参与者中，BMIz 变化与年化 eGFR 变化无显着相关性。

结论

肥胖可能是改善非肾小球性 CKD 儿童肾功能的干预目标。

图形概要

图形摘要的更高分辨率版本可作为补充信息使用