Endocrine Abstracts

Abstract: Glomerular hyperfiltration has been suggested as a possible mechanism linking obesity and chronic kidney disease, independently of classical risk factors such as diabetes. In terms of determining the creatinine clearance has numerous drawbacks, in clinical use are predictors of glomerular filtration rate (GFR) which show varying degrees of accuracy in obese patients. The aim of our study was to determine whether it is in our group of obese patients without type 2 diabetes, glomerular hyperfiltration associated with metabolic disorders. This cross-sectional study included 30 obese patients at the beginning of treatment in Center for Obesity. Excluded were patients with type 2 diabetes, moderate/severe hypertension and cardiovascular comorbidity. We analyzed metabolic parameters (fasting glucose and insulin, HOMA-IR, HbA1c, liver enzymes and renal function (GFR, proteinuria and albuminuria). According to the degree of GFR determined by: 1. the creatinine clearance (CCR); 2. The use of predictors GFR - MDRD and Cockcroft-Gault (CGO) equation, patients were divided into two groups: with hyperfiltration and with normal levels of glomerular filtration rate. According to the level of GFR, 44.4% (CCR), 25.9% (MDRD), 66.7% (CCE) had hyperfiltration, while 55.6% (CCR), 74.1% (MDRD) 33.3% (cGO) patients had normal filtration. Patients with hyperfiltration had significantly higher fasting glycemia (CCR: 4.9±0.8 vs 4.7±0.5, P=0.038; MDRD: 5.1±0.3±0.9 vs 4.9, P=0.039; cGO: 5.2±0.9 vs 4.7±0.5, P=0.049) and HbA1c (CCR: 6.1±0.4 vs 5.6±0.6, P=0.015; MDRD: 5.8±0.9 vs 5.3±0.3, P=0.022; cGO: 6.1±0.4 vs 5.3±0.3, P=0.038) compared to patients with normal filtration. The value of gamma-GT was significantly higher in the group of patients with hyperfiltration compared another group [CCR: 30 (18–80) vs 24 (15–58), P=0.080; MDRD: 29.5 (19–80) vs 24.5 (15–58), P=0.006; CGO: 41 (15–80) vs 18 (15–27), P=0.003]. In our group of patients has been shown that obese patients with glomerular hyperfiltration had significantly higher values of the parameters of glycemic control and gamma-GT compared to those with normal levels of filtration, regardless of age and BMI, which could suggest important interrelationship among the initial development of chronic kidney disease with rediabetes and nonalcoholic fatty liver disease in obesity.