Measurement of Glomerular Filtration Rate in Obese Patients: Pitfalls and Potential Consequences on Drug Therapy

Overview

Journal Obes Facts

Publisher Karger

Specialty Endocrinology

Date 2011 Jun 25

PMID 21701241

Citations 16

Authors

Gregoire Wuerzner

Murielle Bochud

Vittorio Giusti

Michel Burnier

Affiliations

Soon will be listed here.

Abstract

Epidemiological studies have shown that obesity is associated with chronic kidney disease and end stage renal disease. These studies have used creatinine derived equations to estimate glomerular filtration rate (GFR) and have indexed GFR to body surface area (BSA). However, the use of equations using creatinine as a surrogate marker of glomerular filtration and the indexation of GFR for BSA can be questioned in the obese population. First, these equations lack precision when they are compared to gold standard GFR measurements such as inulin clearances; secondly, the indexation of GFR for 1.73 m(2) of BSA leads to a systematic underestimation of GFR compared to absolute GFR in obese patients who have BSA that usually exceed 1.73 m(2). Obesity is also associated with pathophysiological changes that can affect the pharmacokinetics of drugs. The effect of obesity on both renal function and drug pharmacokinetics raises the issue of correct drug dosage in obese individuals. This may be particularly relevant for drugs known to have a narrow therapeutic range or excreted by the kidney.

Citing Articles

Anticoagulation approach in morbid obesity: a comprehensive review on venous thromboembolism management.

Sorodoc V, Asaftei A, Ceasovschih A, Lionte C, Crisan S, Constantin M Front Pharmacol. 2025; 15:1457280.

PMID: 39741630 PMC: 11685120. DOI: 10.3389/fphar.2024.1457280.

Exploring Adiposity and Chronic Kidney Disease: Clinical Implications, Management Strategies, Prognostic Considerations.

Ozbek L, Abdel-Rahman S, Unlu S, Guldan M, Copur S, Burlacu A Medicina (Kaunas). 2024; 60(10).

PMID: 39459455 PMC: 11509396. DOI: 10.3390/medicina60101668.

Obesity Pillars Roundtable: Body mass index and body composition in Black and Female individuals. Race-relevant or racist? Sex-relevant or sexist?.

Bays H, Gonsahn-Bollie S, Younglove C, Wharton S Obes Pillars. 2023; 4:100044.

PMID: 37990673 PMC: 10662008. DOI: 10.1016/j.obpill.2022.100044.

Chemotherapy and Anticancer Drugs Adjustment in Obesity: A Narrative Review.

Batista J, Marzano L, Silva R, de Sa Rodrigues K, Simoes E Silva A Curr Med Chem. 2022; 30(9):1003-1028.

PMID: 35946096 DOI: 10.2174/0929867329666220806140204.

Increased fat mass index is associated with decreased glomerular filtration rate estimated from cystatin C. Data from Malmö Diet and Cancer cohort.

Laucyte-Cibulskiene A, Nilsson P, Engstrom G, Christensson A PLoS One. 2022; 17(7):e0271638.

PMID: 35862349 PMC: 9302820. DOI: 10.1371/journal.pone.0271638.

References

Stevens L, Levey A . Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol. 2009; 20(11):2305-13. DOI: 10.1681/ASN.2009020171. View

Galletti F, Fasano M, Ferrara L, Groppi A, Montagna M, Mancini M . Obesity and beta-blockers: influence of body fat on their kinetics and cardiovascular effects. J Clin Pharmacol. 1989; 29(3):212-6. DOI: 10.1002/j.1552-4604.1989.tb03315.x. View

Anastasio P, Spitali L, Frangiosa A, Molino D, Stellato D, Cirillo E . Glomerular filtration rate in severely overweight normotensive humans. Am J Kidney Dis. 2000; 35(6):1144-8. DOI: 10.1016/s0272-6386(00)70052-7. View

Sparreboom A, Wolff A, Mathijssen R, Chatelut E, Rowinsky E, Verweij J . Evaluation of alternate size descriptors for dose calculation of anticancer drugs in the obese. J Clin Oncol. 2007; 25(30):4707-13. DOI: 10.1200/JCO.2007.11.2938. View

Boer P . Estimated lean body mass as an index for normalization of body fluid volumes in humans. Am J Physiol. 1984; 247(4 Pt 2):F632-6. DOI: 10.1152/ajprenal.1984.247.4.F632. View

Ribstein J, du Cailar G, Mimran A . Combined renal effects of overweight and hypertension. Hypertension. 1995; 26(4):610-5. DOI: 10.1161/01.hyp.26.4.610. View

Blouin R, Warren G . Pharmacokinetic considerations in obesity. J Pharm Sci. 1999; 88(1):1-7. DOI: 10.1021/js980173a. View

Verhave J, Fesler P, Ribstein J, Cailar G, Mimran A . Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005; 46(2):233-41. DOI: 10.1053/j.ajkd.2005.05.011. View

Stevens L, Schmid C, Greene T, Zhang Y, Beck G, Froissart M . Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010; 56(3):486-95. PMC: 2926290. DOI: 10.1053/j.ajkd.2010.03.026. View

10.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

11.

Fox C, Larson M, Leip E, Culleton B, Wilson P, Levy D . Predictors of new-onset kidney disease in a community-based population. JAMA. 2004; 291(7):844-50. DOI: 10.1001/jama.291.7.844. View

12.

Dionne R, Bauer L, Gibson G, GRIFFEN Jr W, Blouin R . Estimating creatinine clearance in morbidity obese patients. Am J Hosp Pharm. 1981; 38(6):841-4. View

13.

Mokdad A, Ford E, Bowman B, Dietz W, Vinicor F, Bales V . Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2002; 289(1):76-9. DOI: 10.1001/jama.289.1.76. View

14.

Hollenstein U, Brunner M, Schmid R, Muller M . Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing. Int J Obes Relat Metab Disord. 2001; 25(3):354-8. DOI: 10.1038/sj.ijo.0801555. View

15.

Vupputuri S, Fox C, Coresh J, Woodward M, Muntner P . Differential estimation of CKD using creatinine- versus cystatin C-based estimating equations by category of body mass index. Am J Kidney Dis. 2009; 53(6):993-1001. PMC: 3028436. DOI: 10.1053/j.ajkd.2008.12.043. View

16.

Janmahasatian S, Duffull S, Chagnac A, Kirkpatrick C, Green B . Lean body mass normalizes the effect of obesity on renal function. Br J Clin Pharmacol. 2008; 65(6):964-5. PMC: 2485235. DOI: 10.1111/j.1365-2125.2008.03112.x. View

17.

Peters A, Glass D . Use of body surface area for assessing extracellular fluid volume and glomerular filtration rate in obesity. Am J Nephrol. 2009; 31(3):209-13. DOI: 10.1159/000271272. View

18.

Korsager S . Administration o gentamicin to obese patients. Int J Clin Pharmacol Ther Toxicol. 1980; 18(12):549-53. View

19.

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

20.

Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P . Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol. 2005; 16(3):763-73. DOI: 10.1681/ASN.2004070549. View