Published date: Sep 26 2019

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 14 (2019), Issue No. 3

Pages: 143–151

DOI: 10.18502/sjms.v14i3.5214

Abozaid Mohammed Elemamdepartment of clinical chemistry faculty of medical laboratory science Omdurman Islamic University

Background: Previously, it has been demonstrated that obesity is one of the strongest risk factors for incident chronic kidney diseases (CKDs). Currently, we examine the association between Body mass index (BMI) and CKD in first degree relatives (FDRs) of renal failure patients on hemodialysis.

Materials and methods: In a cross-sectional study, 135 FDRs of end-stage renal disease (ESRD) patients on hemodialysis were included. Serum creatinine, uric acid, calcium, phosphate, and alkaline phosphatase were measured. Glomerular filtration rate (e-GFR) and albumin to creatinine ratio (ACR) were estimated. The height in Cm, weight in Kg was measured, and the BMI was calculated.

Results: Females 64% were found to have a higher frequency than males 36%. The frequency of BMI categories was found to be 26.7% obese, 26.7% overweight, and 46.6. % normal weight. The mean BMI was (26.0 ± 6.62). The prevalence of CKDs is 19.3% among relatives. CKDs were more frequent 42.3 % in obese, followed by 30.8 % in overweight and 26.9% in normal-weight relatives. Obese and overweight relatives have significantly higher ACR than normal weight (P= 0.012). GFR found to be significantly higher in obese and overweight relatives than normal weight (P = 0.000). GFR was negatively correlated with BMI (R = - 0.430, P = 0.000).     

Conclusion: Obese and overweight RF relatives had higher ACR and lower eGFR. Therefore, obese and overweight members are at higher risk of developing CKD. 

Keywords: CKDs, Family members, BMI, Obesity, ACR, eGFR.

Corresponding author: Abozaid Mohammed Hamid, email: elemam69@hotmail.com

[1] Kumar J. Screening for Chronic Kidney Disease in Family Members of Dialysis Patients. Journal of Rawalpindi Medical College. 2017 Sep 30; 21(3):262-4.

[2] Chukwuonye II, Ogah OS, Anyabolu EN, Ohagwu KA, Nwabuko OC, Onwuchekwa U, Chukwuonye ME, Obi EC, Oviasu E. Prevalence of chronic kidney disease in Nigeria: systematic review of population-based studies. International journal of nephrology and renovascular disease. 2018; 11:165.

[3] Sayanthooran S, Magana-Arachchi DN, Gunerathne L, Abeysekera T. Potential diagnostic biomarkers for chronic kidney disease of unknown etiology (CKDu) in Sri Lanka: a pilot study. BMC nephrology. 2017 Dec;18(1):31.

[4] Chukwuonye II, Ohagwu KA, Adelowo OO, Chuku A, Obi EC, Onwuchekwa U, Anyabolu EN, Oviasu E. Prevalence and Predictors of Chronic Kidney Disease in a Semiurban Community in Lagos. International journal of nephrology. 2019; 2019.

[5] Meyers AM. Significance, definition, classification and risk factors of chronic kidney disease in South Africa. SAMJ, S. Afr. med. j. vol.105 n.3 Cape Town Mar. 2015 http://dx.doi.org/10.7196/SAMJ.9412)

[6] Kumela Goro K, Desalegn Wolide A, Kerga Dibaba F, Gashe Fufa F, Wakjira Garedow A, Edilu Tufa B, Mulisa Bobasa E. Patient Awareness, Prevalence, and Risk Factors of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Patients at Jimma University Medical Center, Ethiopia. BioMed Research International. 2019;2019.

[7] Kong X, Liu L, Zuo L, Yuan P, Li Z, Li W, Cai M, Chen X, Jiang A, Long G, Xu J. Association between family members of dialysis patients and chronic kidney disease: a multicenter study in China. BMC nephrology. 2013 Dec;14(1):19.

[8] Abu-Aisha H, Elhassan A, Khamis A, Abu-Elmaali A. Chronic kidney disease in police forces households in Khartoum, Sudan: pilot report. Arab Journal of Nephrology and Transplantation. 2009;2(2):21-6.

[9] Evangelista LS, Cho WK, Kim Y. Obesity and chronic kidney disease: A populationbased study among South Koreans. PloS one. 2018 Feb 28; 13(2):e0193559.

[10] Ahmed MH, Ali YA, Awadalla H, Elmadhoun WM, Noor SK, Almobarak AO. Prevalence and trends of obesity among adult Sudanese individuals: Population based study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017 Dec 1; 11:S963-7.

[11] Chang TJ, Zheng CM, Wu MY, Chen TT, Wu YC, Wu YL, Lin HT, Zheng JQ, Chu NF, Lin YM, Su SL. Relationship between body mass index and renal function deteriorationamong the Taiwanese chronic kidney disease population. Scientific reports. 2018 May 2; 8(1):6908.

[12] Kovesdy CP, Furth SL, Zoccali C, World Kidney Day Steering Committee. Obesity and kidney disease: hidden consequences of the epidemic. Blood purification. 2017;43(4):346-54.

[13] Garland JS. Elevated body mass index as a risk factor for chronic kidney disease: current perspectives. Diabetes, metabolic syndrome and obesity: targets and therapy. 2014; 7:347.

[14] Swartz JE, Perry E, Joy Sand Swartz RD. Using Peer Mentors to screen for CKD at dialysis units: Targeting high−risk family members. Dialysis & Transplantation. 2011 Jun; 40(6):246-51.

[15] Satko SG, Freedman BI, Moossavi S. Genetic factors in end-stage renal disease. Kidney international. 2005 Apr 1; 67: S46-9.

[16] Bellini MI, Paoletti F, Herbert PE. Obesity and bariatric intervention in patients with chronic renal disease. Journal of International Medical Research. 2019 Jun; 47(6):2326-41.

[17] ElHafeez SA, Bolignano D, D’Arrigo G, Dounousi E, Tripepi G, Zoccali C. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ open. 2018 Jan 1; 8(1):e015069.

[18] Jaar BG, Khatib R, Plantinga L, Boulware LE, Powe NR. Principles of screening for chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2008 Mar 1; 3(2):601-9.

[19] Burtis CA, Ashwood ER, Bruns DE (eds.). Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 4th ed Philadelphia,Pa: WB Saunders, 2006:549

[20] Bevc S, Hojs R, Ekart R, Završnik M, Gorenjak M, Puklavec L. Simple cystatin C formula for estimation of glomerular filtration rate in overweight patients with diabetes mellitus type 2 and chronic kidney disease. Experimental diabetes research. 2012 Sep 12; 2012.

[21] Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Annals of internal medicine. 2006 Aug 15; 145(4):247-54.

[22] Tietz N W. Clinical Guide to Laboratory Tests, 3rd edition. Philadelphia; W.B. Saunders Company 1995: 186- 188.

[23] Chan S, Cameron A, Wang Z, Venuthurupalli SK, Tan KS, Healy HG, Hoy WE. Body mass index in an Australian population with chronic kidney disease. BMC nephrology. 2018 Dec;19(1):209.

[24] Temgoua M, Ashuntantang G, Essi MJ, Tochie JN, Oumarou M, Abongwa A, Mbonda A, Kingue S. Prevalence and Risk Factors for Chronic Kidney Disease in Family Relatives of a Cameroonian Population of Hemodialysis Patients: A Cross-Sectional Study. Hospital Practices and Research. 2019 Jan 26; 4 (1): 12-7.

[25] Hallan S, de Mutsert R, Carlsen S, Dekker FW, Aasarød K, Holmen J. Obesity, smoking, and physical inactivity as risk factors for CKD: are men more vulnerable. American journal of kidney diseases. 2006 Mar 1;47(3):396-405.

[26] Shankar A, Leng C, Chia KS, Koh D, Tai ES, Saw SM, Lim SC, Wong TY. Association between body mass index and chronic kidney disease in men and women: population-based study of Malay adults in Singapore. Nephrology Dialysis Transplantation. 2007 Dec 21;23(6):1910-8.

[27] Nomura I, Kato J, Kitamura K. Association between body mass index and chronic kidney disease: a population-based, cross-sectional study of a Japanese community. Vascular health and risk management. 2009; 5:315.

[28] Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O. Obesity and risk for chronic renal failure. Journal of the American society of nephrology. 2006 Jun 1;17(6):1695-702.3

[29] Choi JI, Cho YH, Lee SY, Jeong DW, Lee JG, Yi YH, Tak YJ, Lee SH, Hwang HR, Park EJ. The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes. Korean journal of family medicine. 2019 May; 40(3):176.

[30] He Y, Li F, Wang F, Ma X, Zhao X, Zeng Q. The association of chronic kidney disease and waist circumference and waist-to-height ratio in Chinese urban adults. Medicine. 2016 Jun;95(25).

[31] Kovesdy CP, Furth SL, Zoccali C, World Kidney Day Steering Committee. Obesity and kidney disease: hidden consequences of the epidemic. Nephron. 2017;135(4):243-51.

[32] Garland JS. Elevated body mass index as a risk factor for chronic kidney disease: current perspectives. Diabetes, metabolic syndrome and obesity: targets and therapy. 2014;7: 347.

[33] Caldararu CD, Tarta D, Pop R, Gliga M, Carasca E, Dogaru G. Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania. Acta Medica Marisiensis. 2016 Jun 1;62(2):225-9.

[34] Brown RN, Mohsen A, Green D, Hoefield RA, Summers LK, Middleton RJ, O’donoghue DJ, Kalra PA, New DI. Body mass index has no effect on rate of progression of chronic kidney disease in non-diabetic subjects. Nephrology Dialysis Transplantation. 2012 Mar 22;27(7):2776-80.

[35] Kalantar-Zadeh K, Rhee CM, Chou J, Ahmadi SF, Park J, Chen JL, Amin AN. The obesity paradox in kidney disease: how to reconcile it with obesity management. Kidney international reports. 2017 Mar 1;2(2):271-81. 32.

[36] Mulyadi L, Stevens C, Munro S, Lingard J, Bermingham M. Body fat distribution and total body fat as risk factors for microalbuminuria in the obese. Annals of nutrition and metabolism. 2001;45(2):67-71.

[37] Pinto-Sietsma SJ, Navis G, Janssen WM, de Zeeuw D, Gans RO, de Jong PE, PREVEND Study Group. A central body fat distribution is related to renal function impairment, even in lean subjects. American Journal of Kidney Diseases. 2003 Apr 1;41(4):733-41.

[38] Kramer H, Reboussin D, Bertoni AG, Marcovina S, Lipkin E, Greenway FL, Brancati FL, Look Ahead Research Group. Obesity and albuminuria among adults with type 2 diabetes: the Look AHEAD (Action for Health in Diabetes) Study. Diabetes Care. 2009 May 1;32(5):851-3.

[39] De Jong PE, Verhave JC, Pinto-Sietsma SJ, Hillege HL. Obesity and target organ damage: the kidney. International Journal of Obesity & Related Metabolic Disorders. 2002 Dec 2;26.

[40] Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U. Glomerular hemodynamics in severe obesity. American Journal of Physiology-Renal Physiology. 2000 May 1;278(5):F817-22.

[41] Koshimura J, Fujita H, Narita T, Shimotomai T, Hosoba M, Yoshioka N, Kakei M, Fujishima H, Ito S. Urinary adiponectin excretion is increased in patients with overt diabetic nephropathy. Biochemical and biophysical research communications. 2004 Mar 26;316(1):165-9.

[42] Tang J, Yan H, Zhuang S. Inflammation and oxidative stress in obesity-related glomerulopathy. International journal of nephrology. 2012;2012.

[43] Kawamoto R, Kohara K, Tabara Y, Miki T, Ohtsuka N, Kusunoki T, Yorimitsu N. An association between body mass index and estimated glomerular filtration rate. Hypertension Research. 2008 Aug;31(8):1559.

[44] Lu JL, Molnar MZ, Naseer A, Mikkelsen MK, Kalantar-Zadeh K, Kovesdy CP. Association of age and BMI with kidney function and mortality: a cohort study. The lancet Diabetes & endocrinology. 2015 Sep 1;3(9):704-14.

[45] Kim YJ, Hwang SD, Oh TJ, Kim KM, Jang HC, Kimm H, Kim HC, Jee SH, Lim S. Association Between Obesity and Chronic Kidney Disease, Defined by Both Glomerular Filtration Rate and Albuminuria, in Korean Adults. Metabolic syndrome and related disorders. 2017 Oct 1;15(8):416-22.

[46] Zaman SB, Hossain N, Rahman M. Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand. Diabetes & metabolism journal. 2018 Aug 1;42(4):330-7.