Abstract
Background and Aims
Recent studies have conflicting findings on the association between obesity and the risk of chronic kidney disease (CKD). BMI by itself is an imperfect marker of metabolically unhealthy obesity. The Pulse Mass Index (PMI) and the Pulse Mass Pressure Product (PMPP) show strong correlation with the risk of cardiovascular disease and may reflect an individual's metabolic energy state. However, it is still unknown whether the PMI and PMPP can be helpful to evaluate glomerular hyperfiltration or hypertrophy, which may exacerbate the progression of CKD. In this study, we measured mean glomerular volume (GV) and single nephron glomerular filtration rate (SNGFR) by estimating the number of nephrons from living kidney donors and we evaluated the effects of PMI and PMPP on glomerular hemodynamic function.
Method
We identified 43 living kidney donors at the Jikei University School of Medicine Hospital from 2007 to 2017 who underwent an enhanced CT scan and a kidney biopsy at donation. The GV was determined by Weibel-Gomez methods and the SNGFR was calculated as eGFR divided by the total number of non-sclerosed glomeruli. The PMI is equal to BMI by resting heart rate (RHR) divided by 1730 and The PMPP is equal to BMI by RHR by systolic blood pressure.
Results
Of 43 subjects, 34.9% were males and with a mean age of 56.1 ± 9.9 years old. Mean Arterial Pressure (MAP) was 86.3±9.9 mmHg, eGFR was 77.4±12.4 ml/min/1.73m2, and urinalysis was normal. The estimated total nephron numbers were 743,204±242,020 /kidney, and SNGFR was 61.7±20.5 nl/min/1.73m2. The GV was strongly associated with both of PMI and PMPP (P=0.0291 and 0.0326, respectively). Interestingly, SNGFR was only associated with PMPP (P=0.0443) but whereas not associated with either age, BMI, or MAP.
Conclusion
In healthy adults, we observed a strong positive correlation between PMPP and both GV and SNGFR. This study indicates that PMPP is a more suitable physical measurement for glomerular hyperfiltration or hypertrophy, and a possible maker of the relative risk of CKD at the long term.
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