scholarly journals Obesity Related Glomerulopathy in adolescent women: the effect of Body Surface Area

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005312021
Author(s):  
Dana Bielopolski ◽  
Neha Singh ◽  
Ohad S. Bentur ◽  
Yael Renert- Yuval ◽  
Robert MacArthur ◽  
...  
Keyword(s):  
New York ◽  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Estimated Glomerular Filtration Rate ◽  
Health Records ◽  
Adolescent Women ◽  
Age Appropriate ◽  
Ideal Body

Background: Adolescent obesity, a risk factor for cardio-renal morbidity in adulthood, has reached epidemic proportions. Obesity-related glomerulopathy (ORG) has an early reversible stage of hyperfiltration. Age-appropriate formulae for estimated glomerular filtration rate (eGFR), which are standardized to ideal body surface area (BSA) and provide assessment of kidney function in mL/min/1.73 m2 units, may underestimate prevalence of early ORG. We investigated whether adjusting eGFR to actual BSA more readily identifies early ORG. Methods: We studied a cohort of 22,417 young individuals ages 12-21 years from a New York metropolitan multi-institutional electronic health records clinical data base. eGFR was calculated in two ways: BSA-standardized eGFR; and absolute eGFR. Hyperfiltration was defined above a threshold of 135mL/min/1.73 m2 or 135 mL/min, respectively. The prevalence of hyperfiltration according to each formula was assessed in parallel to creatinine clearance. Results: Serum creatinine values and hyperfiltration prevalence according to BSA-standardized eGFR were similar, 13.4-15.3%, across Body Mass Index (BMI) groups. The prevalence of hyperfiltration determined by absolute eGFR differed across BMI groups: Underweight - 2.3%; Normal 6.1%; Overweight - 17.4%; Obese - 31.4%. This trend paralleled the rise in creatinine clearance across BMI groups. Conclusions: Absolute eGFR more readily identifies early ORG than the currently used formulae, which are adjusted to a standardized BSA, not representative of current population BMI measures. Using Absolute eGFR in clinical practice and research may improve the ability to identify, intervene and reverse early ORG, which has great importance with increasing obesity rates.

scholarly journals Impossibility of Comparing Data of Indexed Peritoneal Creatinine Clearance when Different Formulae of Body Surface Area are Used

2015 ◽  
Vol 1 (1) ◽  
pp. poc.5000191
Author(s):  
Giancarlo Ruggieri
Keyword(s):  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Stable Condition ◽  
Clinical Applications ◽  
Physiological Variable ◽  
Renal Clearances ◽  
Body Mass Indexes ◽  
Paired T Test

Background This study aimed to determine the differences arising form indexing a measured physiological variable by using different body surface area (BSA) estimation formulae. Methods The studied variables were the overall measured peritoneal creatinine clearance plus residual renal clearances (MeasCtCl) of 19 men and 23 women in a stable condition who were undergoing peritoneal dialysis and were a mean 55.7 ± 15.8 and 55.1 ± 14.1 years of age, respectively. The patients had comparable body mass indexes (BMIs; 25.01 ± 4.14 in men and 24.5 ± 3.46 in women). The MeasCtCls were indexed to 1.73 m2 using 5 formulae: by Du Bois, Boyd, Mosteller, Livingston and Yu. The numerical and percentage differences between the MeasCtCl values and each approach to indexation were calculated, as well as the differences between the indexations. Paired t-test and similarity percentage test were used to evaluate the significance of the differences. Results The impossibility of adequately comparing data indexed according to different BSA estimation formulae was shown, documenting a high risk of erroneous evaluations and conclusions. Conclusions Some methods to avoid these errors in clinical applications are suggested, as well as the possibility of indexing only to height.

Creatinine clearance: enzymatic vs Jaffé determinations of creatinine in plasma and urine.

1986 ◽  
Vol 32 (2) ◽  
pp. 388-390 ◽  
Author(s):  
F Apple ◽  
C Bandt ◽  
A Prosch ◽  
G Erlandson ◽  
V Holmstrom ◽  
...  
Keyword(s):  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Normal Subjects ◽  
Urine Samples ◽  
Plasma Creatinine ◽  
Plasma And Urine Samples

Abstract We measured creatinine in plasma and urine samples from 17 normal subjects and 10 renally impaired subjects by four different methods: two enzymatic--Ektachem iminohydrolase and Boehringer Mannheim amidohydrolase--and two Jaffé reaction based--Beckman Astra 8 and Technicon AutoAnalyzer I. Creatinine clearances, standardized for body surface area, were also calculated. In both groups of subjects plasma creatinine values were significantly (p less than 0.05) lower, by 3 to 4 mg/L, when measured enzymatically than when measured by the Jaffé reaction. Additionally, creatinine clearances were significantly (p less than 0.05) greater by at least 30 mL/min when calculated from enzymatically measured creatinine values vs Jaffé method values for creatinine. The benefits of lack of interference with enzymatically measured creatinine concentrations and clearances should be assessed in relation to the lack of agreement with long-established (Jaffé) methods for determining creatinine (and inulin) clearances.

Body Surface Area Limitations in Achieving Adequate Therapy in Peritoneal Dialysis Patients

1996 ◽  
Vol 16 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Michael V. Rocco
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
High Dose ◽  
Dialysis Patients ◽  
Ultrafiltration Rate ◽  
Peritoneal Equilibration Test ◽  
Transport Type

Objective To estimate the maximal body surface area (BSA) at which an uric chronic peritoneal dialysis patients can achieve adequate peritoneal dialysis using a variety of continuous ambulatory peritoneal dialysis (CAPD) and cycler regimens. Adequate dialysis was defined as a creatinine clearance of either 60 L/week/1.73 m2 or 70 L/ week/1.73 m2. Design Calculation of daily peritoneal creatinine clearances using standard formulas. For CAPD patients, creatinine clearance was calculated using published values for dialysate-to-plasma ratios for creatinine (DIP cr) measured over a 24-hour period and assuming a daily ultrafiltration rate of 1.5 to 2.0 L/day. For cycler patients, creatinine clearance was calculated for both one and two-hour dwell volumes, using published values for DIP cr from the peritoneal equilibration test and assuming a daily ultrafiltration rate of 2.0 L/day. All clearances were corrected to a normalized body surface area of 1.73 m2. Results For CAPD patients, 2– L dwell volumes can provide a weekly creatinine clearance of 60 L/week/1.73 m2 in patients with BSA < 1.45 m2 in the high transporter group and with BSA < 1.2 m2 in the low-average transporter group. Increasing dwell volume from 2.0 to 2.5 L increases these BSA limits in the four transport groups by 0.2 0.3 m2. Cycler therapy is not a viable option for patients in the low transporter group, and this therapy can achieve adequate creatinine clearances in patients in the low-average transport group only with large dwell volumes and in patients with BSA < 1.55 m2. However, in the high-average and high transporter groups, cycler therapy provides for superior creatinine clearances compared to CAPD patients using similar dwell volumes. Conclusions Adequate creatinine clearances in anuric patients are most likely to be achieved in patients with BSA > 2.0 m2 if they have high-average or high transport characteristics and are receiving cycler therapy with large dwell volumes and at least one daytime dwell. However, adequate creatinine clearances may be difficult to achieve in an uric patients who have a large BSA an d a low or low-average transport type, regardless of peritoneal dialysis modality. These patients should be considered for either high-dose peritoneal dialysis (multiple daytime and nighttime exchanges) or hemodialysis therapy.

Variability in Creatinine Clearance (Ccr) and Ktn Due to Different Methods of Calculating Volume and Ccr

1996 ◽  
Vol 16 (4) ◽  
pp. 366-369 ◽  
Author(s):  
Chai Luan Low ◽  
George R Bailie ◽  
Ray Rasmussen ◽  
George Eisele
Keyword(s):  
Body Weight ◽  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Ideal Body Weight ◽  
Volume Of Distribution ◽  
Data Sets ◽  
Total Body

Objective This study aimed to compare the correlations between KTN and creatinine clearance (Ccr) calculated by different methods and to determine and compare the correlations between KTN and Ccr. Design Nonrandomized, retrospective analysis of data. Setting Continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic in a teaching hospital. Patients All patients were included for analysis if the data collection was complete for the calculations of KTN and Ccr using five different methods. Interventions Volume of distribution for urea (V) was estimated by four methods: Watson nomogram, ideal body weight (IBW), actual body weight, and total body surface area. Ccr was determined by five methods: Dialysate Ccr was calculated by creatinine (Cr) uncorrected and corrected for the presence of glucose; urinary Ccr was calculated using urinary Cr alone and the average urinary clearance of urea and Cr; and by the Cockcroft and Gault method. Main Outcome Measures Correlations between KTN and Ccr. Results Sixty-three data sets were collected from 52 CAPD patients. The correlations between weekly KTN and Ccr normalized to 1.73 m2 body surface area were found to be highly variable from one method to another (r2 = 0.012 -0.494). For obese patients (20% above IBW), KTN values obtained were more variable using the Watson nomogram compared to the IBW and BSA methods. Conclusion KT/V calculated using the Watson nomogram and the Ccr determined using average of urinary urea and creatinine clearance gave the best correlation (r2 = 0.49).

Abstract 17526: The Role of Endothelial Function on Paroxysmal and Chronic Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Savvas Mazaris ◽  
Dimitris Tousoulis ◽  
Gerasimos Siasos ◽  
Konstantinos Zisimos ◽  
Evangelos Oikonomou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Endothelial Dysfunction ◽  
Left Ventricle ◽  
Endothelial Function ◽  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Left Atrial ◽  
Volume Index

Introduction: Atrial fibrillation (AF) is associated with various cardiovascular diseases. Endothelial dysfunction is well validated as a strong predictor of adverse cardiovascular outcomes. Hypothesis: We hypothesized that endothelial dysfunction affects the development and progression of AF. Methods: We enrolled 152 consecutive subjects with AF. Thirty five subjects had paroxysmal AF and 117 chronic (long standing persistent or permanent) AF. Endothelial function was evaluated by flow mediated dilation (FMD). All subjects underwent two-dimensional echocardiographic assessment. Left ventricle ejection fraction (LVEF) was calculated based on biplane method of discs, left ventricle mass index to body surface area (LVmass/BSA) was calculated with the method of Devereux, left atrial diameter index to body surface area (LAdiam/BSA) was measured from the parasternal window and left atrial volume index to body surface area (LAvol/BSA) was measured based on biplane Simpson’s rule. Results: Subjects with chronic AF compared to subjects with paroxysmal AF were older (73±10 years vs. 66±15 years, p=0.002), had impaired LVEF (44±14% vs. 53±9%, p=0.001) increased LAdiam/BSA (26±4mm/m2 vs. 20±3mm/m2, p<0.001), increased LAvol/BSA (41±9.6ml/m2 vs. 29±7.7ml/m2, p<0.001), increased LVmass/BSA (116±35 gr/m2 vs. 99±29 gr/m2, p=0.06) and impaired creatinine clearance (64±18 ml/min/1.73m2 vs. 83±20 ml/min/1.73m2, p=0.001). Importantly, subjects with chronic AF had impaired FMD compared to subjects with paroxysmal AF (4.09±1.67% vs. 6.83±1.38% p<0.001). In addition, there was an inverse correlation between FMD and LAdiam/BSA (r=-0.53, p<0.001), LAvol/BSA (r=-48, p<0.001), LVmass/BSA (r=-0.364, p=0.007) and a positive correlation between FMD and LVEF (rho=0.30, p=0.003). Interestingly, a linear regression model revealed that subjects with chronic AF had impaired FMD [b=-1.61 95%CI(-2.33 to -0.89), p<0.001] even after adjustment for confounders such as age, sex, LVEF, LVmass/BSA, LAvol/BSA, creatinine clearance, arterial hypertension and the presence of diabetes mellitus. Conclusions: Endothelial dysfunction is associated with atrial remodeling in patients with AF and is implicated in the progression from paroxysmal to chronic AF.

scholarly journals Tigecycline Population Pharmacokinetics in Patients with Community- or Hospital-Acquired Pneumonia

2010 ◽  
Vol 54 (12) ◽  
pp. 5180-5186 ◽  
Author(s):  
Christopher M. Rubino ◽  
Alan Forrest ◽  
Sujata M. Bhavnani ◽  
Gary Dukart ◽  
Angel Cooper ◽  
...  
Keyword(s):  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Population Pharmacokinetic Model ◽  
Pharmacokinetic Model ◽  
Population Pharmacokinetic ◽  
Community Or ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

ABSTRACT Tigecycline is a new-generation of tetracycline (glycylcyclines) and is active in vitro against bacteria that possess any of the classical genes that confer tetracycline resistance through ribosomal protection or efflux pumps. Herein, tigecycline disposition in patients with community- or hospital-acquired pneumonia was described using a population pharmacokinetic model. Additionally, the influence of covariates, such as body surface area, severity of illness, and clinical laboratory measures, on tigecycline disposition was evaluated. An intravenous loading dose of 100 mg was followed by 50 mg of tigecycline every 12 h. The final population pharmacokinetic model was a two-compartment model with linear elimination and with a relationship between tigecycline clearance and body surface area and creatinine clearance. The model was parameterized using total clearance (CL), the volume of the central compartment, distributional clearance from the central to the peripheral compartment, and volumes of distribution at steady state. Relationships between body surface area and creatinine clearance were identified as significant predictors of interindividual variability on CL. This model will serve as the basis for estimating tigecycline exposure for pharmacokinetic-pharmacodynamic analyses for efficacy and safety among patients with community- or hospital-acquired pneumonia.

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