Prevalence of hyperfiltration among US youth/young adults with overweight and obesity: A population-based association study

Abstract

Objective: Determine prevalence of hyperfiltration (high estimated glomerular filtration rate "eGFR" >95th percentile for age/sex) among youth and association with BMI classification.

Methods: With the use of 1999 to 2016 National Health and Nutrition Examination Survey data from 12- to 29-year-olds, data for serum creatinine and thresholds for high eGFR were normed using a metabolically healthy subsample (no albuminuria, healthy weights, normal blood pressures, blood glucoses, lipids, and liver enzymes). Logistic regression examined the association of BMI classification (healthy weight, overweight, and obesity classes 1-3) with hyperfiltration (eGFR > 95th percentile for age/sex), adjusted for diabetes and other covariates.

Results: Of 12- to 29-year-olds (N = 18 698), 27.4% (n = 5493) met criteria for entry into the "healthy subsample" and contributed data to derive normative values for serum creatinine/hyperfiltration thresholds. In the full sample, hyperfiltration prevalence in 12- to 29-year-olds classified as healthy-weight, overweight, and obesity classes 1 to 3 was 4.9%, 4.7%, 6.5%, 8.7%, and 11.8%, respectively (P < .001). In multivariable analysis, obesity classes 2 and 3 were associated with greater likelihood of hyperfiltration (adjusted ORs for class 2: 1.5, 95% CI, 1.1-2.1; and for class 3, 2.1, 95% CI, 1.5-2.9). Diabetes also was associated with hyperfiltration (AOR, 4.0; 95% CI, 2.2-7.4).

Conclusion: Obesity classes 2 to 3 are associated with hyperfiltration in youth. Age/sex-specific norms for creatinine and hyperfiltration thresholds may aid recognition of kidney dysfunction early.

Keywords: hyperfiltration; kidney disease; obesity; overweight.

Figure 1

Sample flow (on the left) alongside the proportion of U.S. children, adolescents, and young adults (by age) in the full sample (N=18,698) meeting criteria for entry into the “healthy” subsample (n=5,493). Criteria for entry into the healthy subsample were: no albuminuria, a healthy body mass index, normal blood pressure, normal blood glucose, no abnormal lipids, and no evidence of fatty liver disease (per liver‐enzyme alanine aminotransferase [ALT]). Weighted percentages are shown: the full sample represents 58,933,923 12‐29‐year‐olds in the US, and the healthy subsample represents 16,130,346 12‐29‐year‐olds in the US

Figure 2

Normative serum creatinine levels (at the fifth, 50th, and 95th percentiles) and estimated glomerular filtration rate (eGFR) thresholds for hyperfiltration among metabolically healthy females (A) and males (B) by age. (A). Healthy females (n = 2872).1 (B). Healthy males (n = 2621). To convert mg/dL to umol/L, multiply by 88.42

Figure 3

Hyperfiltration in 12‐ to 29‐year‐old US youth and young adults (N = 18 698). Hyperfiltration defined as estimated glomerular filtration rate (eGFR) greater than 95th percentile of age/sex normative eGFR, respectively, with norms set by estimating creatinine‐based eGFR in the metabolically healthy subset of 12‐ to 29‐year‐olds in NHANES 1999 to 2016 (n = 5493). Prevalence of hyperfiltration by body mass index (BMI) classification among 12‐ to 29‐year‐old US youth and young adults (N = 18 698) in the overall sample and for each of the four peri‐pubertal age groups studied