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Published in: Pediatric Nephrology 8/2016

01-08-2016 | Original Article

Normalization of glomerular filtration rate in obese children

Authors: Liane Correia-Costa, Franz Schaefer, Alberto Caldas Afonso, Manuela Bustorff, João Tiago Guimarães, António Guerra, Henrique Barros, Ana Azevedo

Published in: Pediatric Nephrology | Issue 8/2016

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Abstract

Background

Glomerular filtration rate (GFR) is conventionally indexed to body surface area (BSA), but this may lead to biased results when applied to subjects of abnormal body size. The aim of our study was to examine the impact of normalization to the BSA and alternative body size descriptors on measured and estimated GFR in overweight and obese children.

Methods

This was a cross-sectional study of 313 children aged 8–9 years old. GFR was measured by 24-h creatinine clearance (CrCl) and additionally estimated from serum creatinine and cystatin C (CysC) using the combined Zappitelli formula, both as absolute values and adjusted to various body size descriptors. The results were compared between 163 normal-weight, 89 overweight and 61 obese children.

Results

Compared to the normal-weight children, mean absolute GFR (both measured and estimated) was higher in the overweight and obese children, whereas BSA-adjusted GFR was lower. Linear regression models fitted in normal-weight children revealed equally close associations between absolute GFR and squared height, ideal body weight (IBW) and BSA derived from IBW. Normalization of GFR to the IBW-derived BSA completely eliminated the discrepancy between absolute and BSA-indexed GFR in overweight and obese children.

Conclusions

Indexing of GFR to BSA calculated from the ideal—rather than actual—body weight is a promising approach to avoid overcorrection when studying obese children. Further studies should assess the accuracy of this approach across the full range of age and BMI distribution.
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Metadata
Title
Normalization of glomerular filtration rate in obese children
Authors
Liane Correia-Costa
Franz Schaefer
Alberto Caldas Afonso
Manuela Bustorff
João Tiago Guimarães
António Guerra
Henrique Barros
Ana Azevedo
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 8/2016
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-016-3367-8

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