Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortiumBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5301 (Published 10 January 2019) Cite this as: BMJ 2019;364:k5301
All rapid responses
Adiposity and risk of decline in glomerular filtration rate. A personalized approach.
Alex R Chang, Morgan E Grams et al, (BMJ 2019; 364:k5301, 10 January 2019) of the Chronic Kidney Disease Prognosis Consortium (CKD-PC), present strong evidence of the relation between adiposity and decline in glomerular filtration rate (GFR). The most important known risk factors for the decline in GFR are the high blood pressure, diabetes and now obesity. Body Mass Index (BMI) of 30 or more is the most used classification of obesity.
In the daily practice, a very simple initial approach to estimate the GFR (eGFR) is to divide one by the serum creatinine (e.g. Creatinine 1.5 mg, 1/1.5, eGFR 0.66). At the other hand, our long term observation indicates a high correlation (over 90%) between an elevated Pulse Mass Pressure Product (PMPP) and the presence of type 2 diabetes, pre-diabetes, dyslipidemia and metabolic syndrome. All of them risk factors for decline of GFR.
The normal values of PMPP (RHR x BMI x SBP) are round 200,000 (Resting Heart Rate 72 x BMI 24 x Systolic Blood Pressure 115). A PMPP of 300,000 (1.5x the normal range, e.g. RHR 75 x BMI 31 x SBP 130), highly correlates with the risk factors mentioned above. It is to assume that a PMPP of 300,000 (1.5x) or above could contribute to a decline on the eGFR.
If we do the simple calculation of 1/creatinine/PMPP of 1.5x or more, we could eventually have rapid approximation of the eGFR personalized for this patient. For example, given a creatinine of 1.5 mg and a PMPP of 1.5 (300,000/200,000), the initial estimation of the GFR for this patient would be 1/1.5/1.5 or eGFR of 0.44
I invite the Chronic Kidney Disease Prognosis Consortium and other interested researchers to test this simple calculation against more precise but elaborated measurements of GFR.
Prof. Enrique Sanchez Delgado MD
Internal Medicine-Clinical Pharmacology and Therapeutics
Hospital Vivian Pellas, Managua, Nicaragua
Competing interests: No competing interests