Prevalence of Renal Insufficiency in Individuals with Hypertension and Obesity/Overweight: The FATH Study
Pablo Gomez*,
Luis Miguel Ruilope,
Vivencio Barrios,
Jorge Navarro,
Miguel Angel Prieto||,
Olga Gonzalez¶,
Lucía Guerrero,
Miguel Angel Sanchez Zamorano,
Claudia Filozof on behalf of the FATH Study Group
* Nephrology Department, Hospital del SAS, Jeréz de la Frontera, Hypertension Unit and ¶ Endocrinology Unit, Hospital 12 de Octubre, and Cardiology Department, Hospital Ramón y Cajal, Madrid, Salvador Pau, Health Center, Valencia, || Vallobin Concinos Health Center, Oviedo, and Scientific Department, Bristol-Myers Squibb, Madrid, Spain
Address correspondence to: Dr. Pablo Gomez, Nephrology Department, Hospital del SAS, Jerez de la Frontera, Spain (11407). Phone/Fax: +34-956-032556; E-mail: pgomezf{at}senefro.org
Overweight and obesity are associated with increased cardiovascularrisk. Some studies have demonstrated that they also can resultin renal damage. The aim of this study was to assess the prevalenceof renal insufficiency (RI), defined as a GFR <60 ml/minper 1.73 m2, in a cohort of 4585 patients who attended primarycare with essential hypertension and a body mass index 25 kg/m2.The patients were classified as overweight and obese accordingto body mass index (25 to 29.9 and 30 kg/m2, respectively).Abdominal obesity was defined as a waist circumference 88 and102 cm in women and men, respectively. Both groups had a highprevalence of metabolic syndrome (Adult Treatment Panel III).The prevalence of RI was high in both the overweight group (22.7%;95% confidence interval [CI] 20.6 to 24.9) and in the obesegroup (22.8%; 95% CI 21.0 to 24.7). The presence of diabetesincreased the risk for RI (odds ratio 1.83; 95% CI 1.55 to 2.16).The prevalence of RI was greater in patients with abdominalobesity (23 versus 17%; P < 0.001). In the presence of abdominalobesity, cardiovascular risk factors and components of the metabolicsyndrome also were more prevalent. The higher risk for RI withabdominal obesity persisted even after adjustment for dyslipidemia,elevated blood glucose levels, and other variables that areassociated with RI (adjusted odds ratio 1.40; 95% CI 0.84 to2.33). It was concluded that patients who have hypertensionand visceral obesity and attend primary care present a higherprevalence of metabolic syndrome and RI.
Chronic kidney disease (CKD) is a widely known cardiovascularrisk factor. Renal insufficiency (RI) and micro- or macroalbuminuria,both manifestations of CKD, are associated with increased cardiovascularmorbidity and mortality (1–4).
The application of equations to estimate GFR has revealed animportant and growing prevalence of CKD, associated with vascularevents both in population-based studies and in patients withcardiovascular risk factors (5,6). Some epidemiologic studieshave demonstrated an association between obesity and CKD. Ahigh body mass index (BMI) increases the risk for a reducedGFR in both men and women (7). Obesity can be associated withglomerulosclerosis and also can facilitate a loss of renal functionin patients with other kidney diseases (8,9). The risk for presentingRI as defined by a GFR <60 ml/min per 1.73 m2 and end-stagerenal failure as defined by the need for kidney transplant ordialysis increases with the rise in BMI (10,11).
It therefore is likely that increased prevalence of CKD couldbe due, at least partially, to an increase in comorbiditiessuch as overweight and obesity and the combination of associatedhemodynamic and metabolic disorders that result in metabolicsyndrome (MS). Awareness of the association between overweight/obesityand RI is important to adopt preventive and therapeutic measuresfor this risk factor of CKD. The present study assessed theprevalence of one specific manifestation of CKD, low GFR, inpatients with essential hypertension and overweight/obesityseen in primary care.
This cross-sectional, multicenter study recruited a total of4585 patients who attended Spanish primary care centers, previouslyreceived a diagnosis of essential hypertension, and a had bodymass index (BMI) 25 kg/m2. Each investigator included four patientswith hypertension and overweight (BMI 25 to 29.9 kg/m2) andfour patients with hypertension and obesity (BMI 30 kg/m2).BP measurements were performed with a validated semiautomaticapparatus (Omron, Banockburn, IL) with a cuff size adapted tothe arm circumference. Patients were considered to have hypertensionwhen they had previously received a diagnosis of this conditionand/or were taking antihypertensive treatment. The presenceof abdominal obesity was defined by a waist circumference 88cm (female) and 102 cm (male). Patients were considered to presentMS when they fulfilled defining criteria of the Adult TreatmentPanel III (12). The comparative data using the criteria establishedby the International Diabetes Federation also were included(13). Patients were considered to have diabetes when they hadpreviously received a diagnosis of this condition and/or weretaking antidiabetic treatment. All patients were asked abouttheir smoking habits and the presence of any previous cardiovasculardisease (ischemic heart disease, heart failure, stroke, or peripheralarterial disease) and any manifestation of chronic renal disease(renal insufficiency, hematuria, or proteinuria).
Within 7 d, the following parameters were analyzed in plasmaafter 8 h of fasting: Glucose, HbA1c, cholesterol, LDL cholesterol,HDL cholesterol, triglycerides, and creatinine. GFR was estimatedfrom the serum creatinine using the simplified Modificationof Diet in Renal Disease (MDRD) (14) and Cockroft-Gault (C-G)equations (15). The degree of renal function was establishedaccording to National Kidney Foundation guidelines (16). RIwas defined as a GFR by MDRD <60 ml/min per 1.73 m2.
The primary objective of the Factores Adicionales que dificulTanel control en Hipertensos obesos (FATH) study was to analyzethe prevalence of MS in patients with essential hypertensionand overweight/obesity. In this post hoc substudy, the objectivewas to study the prevalence of RI in this population.
Statistical Analyses
Variables are expressed as the mean (SD) or frequency (95% confidenceinterval [CI]). Patients were classified by BMI into overweightor obese patients and by waist circumference into abdominalobesity/no abdominal obesity. The 2 test was used to compareproportions of overweight and obese patients. Comparison ofmeans between overweight and obese patients and between abdominalobesity or not was done using the t test. Consistency betweenGFR by MDRD and by C-G was estimated using the Bland-Altmanmethod. Logistic regression was applied to estimate the riskof GFR <60 ml/min per 1.73 m2 as a result of the presenceof abdominal obesity before and after adjustment for other covariates.Two-tailed comparisons were made throughout, and P < 0.05was considered statistically significant. The analysis was carriedout using SPSS for Windows (version 12.0; SPSS, Chicago, IL).
A total of 2206 men and 2379 women with a mean age of 61.9 yr(10.6 yr) were studied. Of these, 32.9% (95% CI 30.7 to 33.4)had previously received a diagnosis of diabetes; 3.6% (95% CI3.10 to 4.2%) were aware that they had chronic renal disease.Table 1 shows the characteristics of patients who were classifiedaccording to BMI into overweight or obese patients. The meanvalues of waist circumference were higher in the obese group,who also presented higher plasma glucose concentrations anda higher degree of dyslipidemia. The prevalence of MS by AdultTreatment Panel III criteria was 80.2% (95% CI 78.01 to 82.26)and 92.83% (95% CI 91.5 to 94.5) in the overweight and obesegroups, respectively (P < 0.0001) and when InternationalDiabetes Federation criteria were applied was 85.37 (95% CI83.4 to 87.18) and 95.12 (95% CI 94.01 to 96.01) of the overweightand obese patients, respectively. There was a higher prevalenceof diabetes in the obesity group. The overweight patients hadsimilar systolic BP and diastolic BP values to those of theobese patients. There was a higher prevalence of smokers inthe overweight group (28.9 versus 23%; P < 0.0001). The GFRby C-G was higher than that calculated by MDRD with a mean differenceof 4.72 ml/m per 1.73 m2 in the overweight group and 24.7 ml/mper 1.73 m2 in the obesity group (Figure 1).
Figure 1. Bland-Altman plot comparing two methods to estimate the GFR (Cockroft-Gault and MDRD) in overweight (A) and obese (B) hypertensive patients.
There were no significant differences in the prevalence of renalinsufficiency (GFR <60 ml/m per 1.73 m2) between overweightand obese patients (23% [95% CI 21 to 25%] versus 23% [95% CI21 to 25%]; Table 2). In both the overweight and the obese groups,patients with diabetes had a higher prevalence of RI (30.1%[95% CI 24.4 to 32.9] versus 19.2% [95% CI 17.6 to 20.8; P <0.0001] in the obese group and 29.1% [95% CI 24.6 to 33.9] versus20.1% [95% CI 18.0 to 22.9] in the overweight patients). Therisk for a GFR 30 to 60 ml/m per 1.73 m2 was 83% greater (oddsratio 1.83; 95% CI 1.55 to 2.16) in the presence of diabetes.When the distribution of GFR along quartiles of waist circumferencewas analyzed, there was a larger proportion of patients withGFR >90 ml/m per 1.73 m2 in the higher percentiles of waistcircumference (P = 0.008 for the trend). A higher prevalenceof RI was observed in patients with abdominal obesity (Table 2).The distribution of risk factors in patients with abdominalobesity is shown in Table 3. Patients with abdominal obesitytended to be older and to present more metabolic alterationsand obesity (BMI 30 kg/m2). The presence of abdominal obesityincreased the risk for presenting a GFR <60 ml/min per 1.73m2 by 55%. After adjustment for all of the components of theMS, this risk was only slightly reduced (odds ratio 1.51; 95%CI 1.13 to 2.01).
This study shows a very high prevalence (23%) of RI (GFR byMDRD <60 ml/m per 1.73 m2) in a relatively large cohort ofadult hypertensive patients with overweight/obesity. Given thedifficulties with accurate estimation of GFR and the limitationsof calculating GFR on the basis of serum creatinine alone, thereis an increased interest in the use of equations (MDRD and C-G).These equations include variables such as age, weight, gender,and race and show a good correlation with accurate markers ofGFR (17). When comparing both equations, the GFR values thatwere obtained with the C-G method were higher, and the differenceswere larger with higher BMI values. Other studies have shownthat, in the presence of obesity/overweight, the C-G methodoverestimates GFR and consider the MDRD equation, especiallyin cases of reduced GFR, to be more accurate (18,19).
In the Spanish population pilot study, the prevalence of GFR<60 ml/m per 1.73 m2 was 5.1% (20), similar to that (5% ofthe population) performed in >500,000 patients in a Canadianpopulation (21). However, when patients with hypertension arestudied, there is a greater prevalence of RI. In a cohort of721 patients who had essential hypertension, a mean age of 56yr, and a BMI of 28.9 kg/m2 and attending a hospital clinic,a GFR <60 ml/min per 1.73 m2 was observed in 16.2% of thepatients (22). In another recently published study (23), theprevalence of a GFR <60 ml/min per 1.73 m2 by MDRD in 13,687patients who had hypertension and were seen in primary carein Spain was 27.7%. Patients who were included in this studywere of similar characteristics to our study group. Most ofthem were overweight or obese, only 17% had normal body weight,and 30.6% had diabetes. The older age (mean 68.1 yr) could explainthe higher prevalence of RI than that observed in our population.In the MicroAluminuria en pacientes con glucemia Basal ALterada(MAGAL) study published in this issue (24), the prevalence ofRI in patients with hypertension and microalbuminuria was 19.9%,but 10% of these patients had BMI <25 kg/m2.
Given the coexistence of hypertension and overweight/obesityin our patients, it is difficult to establish the significanceof each of these in the development of kidney damage. Both inhypertension and in overweight/obesity, as well as in diabetes,glomerular hyperfiltration can occur, which, over time, cancontribute to kidney damage (25,26). Ribstein et al. (26) demonstratedin a comparative study in patients with hypertension that thepresence of obesity causes a higher filtration fraction and,consequently, more microalbuminuria, thus confirming that theincrease in weight intensifies hypertensive renal damage. Microalbuminuriawas not measured in our study. Nonetheless, the greater prevalenceof GFR >90 ml/m per 1.73 m2 in patients in the highest percentileof waist circumference suggest the presence of hyperfiltration,at least at some point during the renal life of patients withhypertension and obesity, a hyperfiltration that contributesto a steady decline of renal function. In the Hypertension Detectionand Follow-Up Program (27), the incidence of chronic renal diseaseat 5 yr, defined by proteinuria and/or GFR <60 ml/min per1.73 m2, was higher in patients with obesity and overweight(31 and 34%, respectively) than in hypertensive patients withideal weight (28%).
No differences in prevalence of RI were observed between overweightor obese patients who were classified according to BMI in ourstudy. A possible explanation is that a cutoff point of 25 kg/m2in hypertensive patients with other risk factors already definesthe increased risk for RI. Besides, BMI indicates only bodycorpulence, and it might be hypothesized that hypertensive patientswith BMI between 25 and 29.9 kg/m2 have more body fat than nonhypertensiveoverweight individuals. Furthermore, it has been reported thathypertensive patients had more visceral adipose tissue accumulation,measured by multiscan magnetic resonance imaging, than nonhypertensivecontrol subjects for a similar fat mass (28). In fact, our studyshows that patients with abdominal obesity have a significantlylower GFR and that there are more patients with CKD comparedwith non(abdominal)obese patients, supporting the relevanceof abdominal obesity in kidney damage. A study to assess bodyfat and its association with BMI in hypertensive patients iswarranted. On the other side, it has been shown in patientswithout diabetes that, regardless of BMI, central distributionof fat (abdominal obesity) increases the risk for a reductionof GFR (29). The greater prevalence of RI in hypertensive patientswith abdominal obesity could be due to the different metabolicalterations that frequently are associated with this type ofobesity and that constitute the MS. A greater prevalence ofmetabolic alterations was seen in patients with abdominal obesity,although they still have a high risk for RI after adjustmentfor these variables. Therefore, other factors that were notdetermined in this study, such as hyperinsulinemia, increasedsympathetic activity, renin-angiotensin system activation, inflammatorymediators, and other adipocyte-derived products, could playa role in the development of RI that is associated with abdominalobesity and MS (30). As expected, in the presence of diabetes,the prevalence of RI increased significantly in both overweightand obese patients.
Our study reveals that patients who have hypertension and overweight/obesityand are seen in a primary care setting show a high prevalenceof MS and RI in which abdominal obesity plays an important role.Stepping up of preventive and therapeutic measures to controlthese frequent and important vascular risk factors thereforeshould be considered.
Acknowledgments
This study was supported by a Grant from Bristol-Myers Squibb.
The following investigators participated in the FATH Study:Abarca Bujan Benjamín, Abou Pestana Octavio, Abou AssaliBoasli Radwan, Acedo Acedo Ángeles, Adroher VallmajorJordi, Aguera Mengual Fuensanta, Aguilar Jado José Manuel,Aguilera Hurtado Eva, Albarrán Juan Ma Elena, AlbertAmorós Teresa, Alberto Vara Luis, Albors Valls Alberto,Alés Conejo Francisco, Alfageme Perez Jose María,Alfonso González Dacil C., Allué Callizo Davis,Almela Tejedo Teresa, Almirall Banque Carmen, Almiron AlvereteMaria, Alonso Dura Carmen, Alonso Valladares Francisco, AlonsoFernandez Lola, Alonso Quintanilla Luis, Alonso Rosario, AlonsoVal Antonio, Alpas Mabel, Alvarez Alvarez Alfredo, Alvarez CosmeaArtemio, Álvarez Taboas Jorge, Álvarez Gil JoséI., Álvaro Grande Epifanio, Alzua Blanco Luis, AmijibiaCabeza Iziar, Andrés Palomo Inmaculada, Andreu MartínAntonia, Antonio Fernandez Jose, Aparicio Velasco Josefina,Aramburu Aramburo Pedro, Arana Domenech Jesús, AranaTorres Monica, Aranda Vizcaíno Juan Jesús, AreasMedina Virginia, Argona Jesús Juan, Arias Concepción,Arias Garcia Maria Teresa, Arizaga Beatriz, Arranz SanjurjoJosé Ángel, Arribas Aguirregaviría F. Javier,Arriola Mantxola Enrique, Arroyo Azpa Conchita, Artero CanalsFernando, Arteta Barrenetxea Iratxe, Aspiazu RodríguezJuan Carlos, Ave José, Aviño Navarro Arturo, AyalaGonzalez Ángel, Bacariza Riñón Francisco,Badell Gemma, Baeza Romero Manuel, Balaguer Belles Ismael, BalboaJiménez José Luis, Bañuelos Gago MariaJesús, Barbe Riesgo Margarita, Barbera Reus Ramón,Barrancos Heredia Maria Del Rosario, Barreiro Mourenian Carlos,Barrera Pinazo Rosa, Barrero Sanchez Carme, Barrios Santiago,Bartolome Resano Rafael, Basauri Bedoya Jose Manuel, BecerraBecerra A., Becerra Méndez Mercedes, Bellostas ImbertJosé, Benet Marti Josep Maria, Berdonces Jose L., BernardoQuirós Victoria, Blanco Montes Jesús, Blanco PerdigónLuis, Blanco Iglesias Pedro, Blasco Lafarga Blanca, BlÁzquezMa Luisa, Bordes García Laura, Bossom Diumenjo Maria,Botella Gregori Ana, Brunet I Costa Jordi, Burgazzoli SamperJuan Luis, Burgos Bravo Maria Jesus, Busselo Lete Luis Miguel,Buznego Álvarez Begoña, Caballe Godia JoséLuis, Caballero Domenech Joan Carles, Caballero RodríguezJuan, Caballero Montanary Leonides, Cabana Gadea Andrés,Cabedo García Vicente, Cabero Garrido Manuel, CabreraAguilera Mercedes, Cabrera López Raúl, CaixÁsPedragós Assumpta, Calatayud Rodríguez AntonioLuis, Calderón Pérez Rafael, Calles Romero Ignacio,Camacho Ibañez Juan Luis, Camacho Herrera Ma Jesús,Campanario Astete Pedro, Campos Rio Catherine, Campos ToimilLuis, Canales Alfredo, Candilejo Fortes Gabriela, Canelada SanchezJose Antonio, Cano Jiménez Agustín, Cantos AlcañizMari Sol, CapitÁn Caldas Mercedes, Carbonero MartínezAlejandro, Carrasco Herrera Jesus, Carreira Fonta Jose A., CarrerasLópez Ángela, Carvajal Vión Isabel, CasadoMoragón Concepción, Casado Navarro Joaquín,Casal Mendez Luis, Casanova Gil Miguel Ángel, CascanMartín Jose Maria, Castilblanque Ballesteros Consuelo,Castillo Barea Encarnación, Castillo Ballesteros Jesus,Castrillon Rey Maria Jose, Cea Soria Luis, Celatti Gomez Blanca,Cerda Alfonso Vicente, Cerrada Machuca Maria José, CerratoRodríguez Maria, ChÁvez Egea Magdalena, CinosRamos Ma Lourdes, Clar Puig Cristina, Climent Ferri Victor,Cobas Varela Enrique, Cobos Toro Luis, Collado Navas Raquel,Conejero García Vicente, Corominas Sarrio Pilar, CorreaArmero Rosario, Cortes Evaristo, Cortés Ugalde Fernando,Cortizo Torres Maria Emilia, Coscolla Checa Francisco, CostaBroch Pascual, Creixell Sanchez Jaume, Crespo JiménezFloreal, Creus Rey Beatriz, Criado Campomanes Amparo, CristofolLópez Isabel, Cruz Saldaña Francisco, CuatrecasasCambra Gabriel, Cuerpo Álvarez Francisco, Cuesta MenéndezAlfonso, Curado Garcia Carmen, Da Silva Gonzalez Álvaro,Daviña VÁzquez Ma Dolores, De Arriba Frade Fernando,De Barruetabeña Gutiérrez José Miguel,De Castro Peral LÁzaro, De Dios De Dios Ángel,De Dios Mora Juan, De Felipe Medina Ricardo, De Juan AlcarÁzFrancisco, De Juan Puente Jesús, De La Torre Edo Jorge,De La Torre Vidal Montse, De Linares Del Río Carlos,De Rafael Marti Julio, De Tapia Polo Juan Jesús, DelÁguila Padilla Pilar, Del As Gómez Enrique, DelBlanco Niembro Pablo, Del Río Bohorquez Cristobal, DelRío Alonso Jose María, Del Valle Pelayo Juan,Delgado Simón Félix, Delgado Santana Jesús,Diab Nafer, Díaz Alba Ángel, Díaz GallardoBaltazar, Díaz Santiago Carlos, Díaz Paquez Francisco,Diaz Garcia Manuel, Diaz Jiménez Manuel, Diego Coll Carlos,Diego Dominguez Fernando, Diez Andrés María Luisa,Dominguez Velazquez Jesús, División Garrote JuanAntonio, Dolz Del Castelar Pareja Marcial, Domingo Sellart Francesc,Domingo Orduña Manuela, Dominguez Deben Daniel, DominguezMÁrquez Juana, Domínguez Ávila JuliÁn,Dopico Perez Octavio, DurÁn Pérez Susana, EnfedaqueMontes Belén, Enguidanos Garcia Marcia, Erlanz Abad Arturo,Escobar Muñoz Francisco, Escobedo Espinosa Francisca,Escorza Rodríguez Juan M., Esparcia Garcia Mariano, EspinelÁlvarez José, Esplugues Chulvi Carmen, EsquembreMenor Raquel, Estables Recasens Pedro, Esteve Fuster Vicente,Exposito Coll Patricio, Falantes Parrado Manuel, Faus MascarellEmilia, Faxas Margarita, Fernandez Dieguez Elena, FernandezMartín JuliÁn, FernÁndez GÁlvezCristóbal, FernÁndez Ares Jose A., FernÁndezGarcía José María, FernÁndez CasadoPedro, Fernando López Carmen, Ferreiro Carmen, FerrerCaballer Amparo, Fiallega Otero Rafael, Fle Pinilla Isidro,Foguet Boreu Quintí, Fonseca Capdeville Ernesto, ForcadaLozano Juan E., Fornieles Medina Miryam, Fortea Zaragoza Antonio,Fraga Cabado Jose, Fraga Diez Manuel, Francés GómezRaquel, Franch Taix María Gemma, Franco Reche Luis, FuentesFernandez Fernando, Fuster Bellido Tomas, Gaisan Tomo Carmen,Galindo Tobal Francisca, Galindo Ruiz Jose M., Gallardo DíazMiguel, Gallego Piote Sergio, Gallegos Castillero Raimundo,Garay Orte Jon, Garbayo Juan, Garchitorena Peiro Miguel, GarciaSierra Alberto, Garcia Chevarría Belen, Garcia GaliciaFélix, Garcia Jiménez Gerardo, Garcia Tell Guillermo,Garcia Nadal Ignacio, Garcia Blas J. Miguel, Garcia CampilloJoan Manuel, Garcia Sabater Joaquin, Garcia Cabarcos Jose Antonio,Garcia HernÁndez Luis, Garcia Cobelo Maria Emma, GarciaPrieto Mariano, Garcia-Reyes Ramos Mercedes, Garcia ConejeroOlga, Garcia Peñafiel Rafael, Garcia Ochoa RocíoDe Vicente, García García Alberto, GarcíaVallano Isaac, García Allas Isabel, García NorroJavier, García Pérez Jordi, García HidalgoJosé, García Aparicio Judit, García LópezManuel, García Bernal Manuela, García CallejasRicardo, García Urendez Jose, Garrido Sampedro Manuel,Gasalla Rodríguez Concepción, Gascó GarcíaPlÁcido, Gaspar HernÁndez Andrés, GeneGarcía Jose R., Gené García Pedro, GilMonje Maria, Gimenez Navarro María Antonia, GiménezPalop Olga, Giner Garrigues Francisco, Giner Lacuesta Isabel,Gippini Pérez Antonio, Girón Daviña Marta,Gispert Servitge Adria, Goikoetxea Arrillaga Alejandro, GomaraSonia, Gómez Ruiz Javier, Gómez Gonzalez Laureano,Gómez Mendicuti Manuel, Gómez Fumero Sonsoles,Gómez Aguinaga Juan Manuel, Gómez Ribelles Rafael,Gonzalez López Belén, Gonzalez Gago Jose Antonio,Gonzalez Gonzalez Juana, Gonzalez Cuber Lamberto, GonzÁlezLorrio Francisco, Gonzalez Gonzalez Luis, Gonzalez LópezArce Luis, Gonzalez Moreiras Manuel, Gonzalez Cabrera Marcos,GonzÁlez Álvarez Antonio, GonzÁlez GalÁnConcepción, GonzÁlez Acuña Eduardo, GonzÁlezGonzÁlez Javier, GonzÁlez Rodríguez Luis,GonzÁlez Rodríguez Manuel, GonzÁlez CandelaRosario, Gonzalo Carlos, Gorriz Santamaría Elena, GorrotxtegiEreño Jesús, Goterris Pinto Marian, Granado SanchezFrancisco José, Gras Balaguer Santiago, Guardiola GrauBegoña, Guerrero Reina Salvador, Guillen Garcia Francisco,Guillen Hdez. Monserrat, Gutiérrez Delgado Eduardo, GutiérrezMéndez José Luis, GuzmÁn Martí JuanA., Guzon Méndez Fernando, Helguera Jose Luis, HerediaCabrera Francisco, Hernaez Cabañas Luis F., HernÁndezPérez Ana, HernÁndez Surroca Daniel, HernÁndezDíaz Francisco, HernÁndez Gutiérrez JuanaIsabel, HernÁndez Moreno Julio, HernÁndez Pedro,HernÁndez García Concepción, HernÁndezRico Filomena, HernÁndez Iglesias Juan José, HernÁndezRodríguez Maria Dolores, HernÁndez Herrera Ricardo,Herran Oteruelo Luis Ángel, Herrera HernÁndezEduardo, Hevia Rodríguez Eduardo, Hidalgo Santiago JuanCarlos, Hinojosa Gallardo Juan Luis, Ibor Vidal Encarnación,Iglesias Fernandez Federico, Imaz Pérez Francisco, InestaMena Claudia, Iraola Sierra Begoña, Irizabal Navas JuanCruz, Jane Jaures Antoni, Jiménez CÁmara Antonio,Jiménez Rodríguez Maria Ángeles, JiménezJerez Maria Del Carmen, Jiménez CÁmara Valentín,Jiménez Garijo Diego, Jiménez Herrera JoséMaría, Jiménez Notario Manuel, JiménezSamper Milagros, Jorge Sanchez Ramón J., Juan AlberolaVicente, Kern Volcy Edouard José, Laborda EsteruelasMontse, Laiseca Sagardui Javier, Lalinde Herrero Martín,Lamarca Roca Angels, Lara Fornelino Luis Felipe, Lasso OriaVirginia, Latorre Atienza Marco A., Leal Correa Bartolome, LeiraPaz Gloria, Lemus Gallego Juan Luis, Lezaun Indurain Ana, LilloGallego Paco, Linares Lorenzo Francisco, Llenares Orts JoséF., Llorente Gómez De Segura Iñaki, Lluna GascoCarlos, López Abietar María Isabel, LópezGarcía Celia, López Serrano Beatriz, Lopez VarelaCarmen, López De La Iglesia Jaime, López VÁzquezJose Luis, López Toledo Ma Luisa, López QuinteroPurificación, López Luque Santiago Rafael, LópezMitxelena Teresa, López Aisa Blanca, López OrtizFrancisco, López Cambeses Rosario, López CrespoYolanda, Lozano Cobos Antonio, Luengo Agüero Jesus, MaciaPérez Ramón, Madero Ambrojo Emilio, MagadalenaBelio José Félix, Mahiques García Elvira,Malagas Ferrera Herminio, Mansilla Rodríguez Calixta,Marco Segarra Emili, Marín De La Cueva Juan Antonio,Marín IbÁñez Alejandro, Marín OsorioCarmen, Marion Navasa Gonzalo, Marti Corominola Andreu, MartínPeces Blanca, Martín Pérez Enrique, MartínSanchez Jose, Martín Jiménez Juan Antonio, MartínCollado Manolo, Martín BlÁzquez Mercedes, MartínFresneda Soledad, Martín Alegre Amparo, MartínRuiz Aurelio, Martín Domenech Ignacio, MartínLafoz Juan Carlos, Martín Gonzalez Luis, MarínMoros José María, Martínez Garcia Agustín,Martínez Ruiz Andrés, Martínez RossellóAntonio, Martínez Bravo Bernardino, Martínez QuessDulce, Martínez Ortega Francisco, Martínez PiquerJoaquín, Martínez Orozco Marino, MartínezLlarena Marisa, Martínez Mercedes, Martínez FernandezMontserrat, Martínez Pardo Rafael, Martínez LuqueFrancisco Javier, Martínez Martínez Ma Jesús,Martos Calzado José, Massana Toro Pere, Matellanes MatellanesÁngel, Mateos Freire Sergio, Mato Marcos Fernando, MatosesNacher Daniel, Mayques Alos José Luis, Medina Maya JoseAntonio, Medina Cuenca Pedro, Melo Faus Juan Bta, Mena GarciaCandido, Mena Pena Maria, Méndez Gómez Begoña,Méndez Robles Jesús, Méndez Delagado Manuel,Merina Sanchez Rafael, Mesa Pedrero Carlos, Minchero Alberto,Mingo Belloso Yolanda, Minuesa Cortijo Francisco Javier, MiñanaAguado Sandra, Miñano FernÁndez Pilar, MolinaMolina Felipe, Molina De Heras Miguel, Monblan Díaz Eva,Monge García José Manuel, Monraba Ferrer JoseM., Monroy Fuenmayor Nieves, Montalvillo Montalvillo Jose Luis,Montesinos E., Moñivas Lijaro Mariano, Morales NavarroFernando, Morales Aranjuez Isabel María, Moralez PérezLola, Moreno Andújar Dolores, Moreno Moreno Eugenio,Morillo VÁzquez Álvaro, Mulero Garcia Maria José,Munguia Alcalde Vicente, Muñoz PelÁez Carmen,Muñoz Rodríguez J.A., Muñoz GalÁnMaria Dolores, Murguizu Garcia Ana, Murie Roig Ana, Muriel DíazPaz, Murillo Torrado Diego, Murillo Torrado Mariano, Nader RamirezRoberto, Nasser Rifai Adel, Navalón Martínez Amparo,Navalón Gómez Pascual, Navarro Navarrete Carmen,Navarro Pérez Jorge, Navarro Sanz Juan José, NavarroVillena Manuel, Nicolau Rerrer Francisca, Nieto Fernandez ArroyoManuel, Nieto Hortal Pepe, Nieto Cervera Rafael, Nogales RebolloGregorio J., Noguera Bennaser Juan, Ocaña Cazalilla Carmelo,Ogallas Raya Fuensanta, Olalde Quintana Rafael, Oliva GomezFco Jose, Olivares Bautista Mari Carmen, Oliveras Montse, OliverasDeulofeu Victor, Olmedo Peñaranda Javier, Orio SeguraEsperanza, Orquín Vera Abelardo, Ortega Cantero Ángel,Ortega Cutillas Mariano, Ortega Jiménez Victor, OrtizDe Santa Maria Jose, Ortiz-Villajos Serrano Carmen, Osca PellicerDavid, Osuna Dominguez José, Otero Toral Ángel,Otero Coton Jose, Otero Rodríguez Rocío, PachesPorcar Maria Dolores, Palacios Villanueva Cayetano, PalomaresMoral Eduardo, Panero Alejandro, Pardo Otero Felipe, ParedesSaura José, Parralejo Cano Francisco, Pascual FusterVicente, Pastor Mira Percebal Isidro, Paz Rodríguez Fabiola,Pazos GonzÁlez Pilar, Peco Bermúdez Benjamín,Pedraza SÁnchez Sonia, Pellicer Muñoz Mónica,Pellit Ramil Ignacio, Pensado Pousa José, PeñaDíaz Dolores, Perea Mostajo Janeth, Pereira Cuello Jesús,Pérez Pérez Carlos, Pérez Gil Javier S.,Pérez Cebrian Maria José, Perez Mira Maria José,Pérez Zamora Susana, Pérez FernÁndez Aurelia,Pérez GonzÁlez Guillermo, Pérez BoronatLuis, Pérez Palmes Mari Paz, Pérez Rivero MiguelA., Perona Pagan Miguel, Picazo Romero Emilio, Piury AlonsoCarlos, Pizarro López Mar, Ponce Martín Jose,Ponce Bejarano Manuel, Ponz Callen Antonio, Prat Mireia, PrietoGirón Jesús, Prieto Díaz Miguel A., PrietoPrieto Raquel, Puchades Chilet Ángeles, Pueyo MartínezManuel, Pujol Dakme Pere, Quintana Ortíz Javier, RabanalCarrera Sandra, Raigda Igada Guerra Antonio, Ramirez MarentJose Ignacio, Ramírez Canca María Teresa, RamírezGonzÁlez Rosa Ma, Ramos Rodriguez Consuelo, Ramos MartínVidal, Razón Angulo Emilio, Regueiro Antonio, RequenaMarín Carmen, Retuerta García María Dolores,Rey Gonzalez Pilar, Ribes Albert Jose, Riuas AlcÁzarGuillermo, Rivero Moreno Antonio, Roberto Echevarri Enrique,Robre Oriete Mariano, Roca Guanter Enric, Rodondo Rico Inmaculada,Rodriguez Arce Angeles, Rodríguez López Elisa,Rodríguez Vicente Isabel, Rodriguez Inchaustegui JoseLuis, Rodríguez Pino Jose Manrique, RodríguezSanchez Juan José, Rodríguez Apresa Ma Dolores,Rodríguez Solureano Maria Antonia, Rodríguez RodríguezMiguel Ángel, Rodríguez HernÁndez Vidal,Rodríguez Poncela Antonio, Rodríguez LópezMercedes, RoldÁn Sanchez Juan Jose, Romaní DelCastillo Javier, Romero GonzÁlez Elena, Romero AtanesJesús, Romero Martín Julia, Rosa Gil Luis, RubioHernÁndez Jose Félix, Rudolphi Carralero Teodoro,Ruiz Comellas Anna, Ruiz Diez Dolores, Ruiz Ferrando Ernestina,Ruiz Franzi Ignacio, Ruiz De Gordeguela Julio, Ruiz Pastor Luis,Ruiz Fernandez Manuel, Ruiz Aragón Rosalía, RuviraMartínez Ernesto, SacristÁn Rubio Alberto, SÁenzGaleano Antonio, Sainz Salazar Ma Félix, Saiz Jose Antonio,Salas Fernando, Salas Tomas, Salgado Cachofeiro JoséAlfonso, Salgado Nieto Vicente, Sanchez Calso Antonio, SanchezGarcia Fernado, Sanchez Mate Isabel, Sanchez Moran Isabel, SanchezViel Isabel, Sanchez Prieto Jaime, Sanchez Coureiro Manuel,Sanchez Santos Natividad, SÁnchez Berbel Baldomero, SÁnchezCarrillo Santiago, Sancho Soriano Natividad, Saniger HerreraJosé Manuel, Sanmartín Almenar Ana, Sansano TrivesRosario, Santana Benítez Jesús, Santiago SÁezAndrés, Santiago Antonio, Santos Altozano Carlos, SantosBueso Isabel María, Santos Godoy Rafael, Sanz RebolloGloria, Sanz García Juan José, Sanz BailónLuis, Sarria Ferrada Jesús, Segarra Codina Ramon, SegreraManzano Silvia, Serrano Contreras Benjamín, Serrano ValverdeLeticia, Serrano-Guerra Librero Fco. Javier, Silva Silva Manuela,Simón Gutierrez Raul, Sirvent Antolin Luis, Sorli GuerolaJose Vicente, Soubriet Velasco Ángel, SuÁrez HernÁndezHector, SuÁrez Castro Nicanor Enrique, SuÁrezFernÁndez Eusebio, Tarradellas Bancus Jose María,Tejero Puerto Francisco, Tisaire Sanchez Javier, Tola GutiérrezBeatriz, Toldos Villegas Gregorio, Torner Perarnau Lluis, TorresIzquierdo Jesus, Torres Exposito Juan, Trujillano Gerardo, ÚbedaPastor María, Valeriola Julvez José María,Valero Barcelo Carmen, Valero Lance Maria Pilar, ValladaresMateu Lluis Carles, Vargas Negrín Francisco, VÁzquezRojo Carlos, VÁzquez García María Dolores,Velasco Escobar Pablo, Velayos Jiménez Enrique, VelazquezFerro Juan Jesús, Ventura Rodriguez Silvestre, VergaraMartín Jesús, Vicente Arroyo Manuel J., Vigil-EscaleraFrancisco, Vila Villarte Carme, Vilano Vives Jordi, Villa EstebanezRubén, Villahoz Castrillejo Rosa, Villalva Quintana Elena,Villanueva Budia Guillermo, Villanueva Gómez Isabel,Villanueva Telleria Jerusalén, Villanueva Rebollo JoséManuel, Villanueva Zarate Jose Ramón, Villar Rivera Marcos,Villarte Perez Ofelia, Villena Machuca Maria Luisa, Viudes PlazaEmilio, Vizuete Gala Carmen, Zamorano Martín Juan Carlos,Zapata Medin Luisa, Zeloro GonzÁlez TomÁs, ZuazagoitiaNubla Jose Félix, Zubiri SÁenz Félix, ZugazaGurruchaga Lucrecia.
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Top
Abstract
Introduction
25 kg/m2. The patients were classified as overweight and obese according to body mass index (25 to 29.9 and 
2 test was used to compare proportions of overweight and obese patients. Comparison of means between overweight and obese patients and between abdominal obesity or not was done using the t test. Consistency between GFR by MDRD and by C-G was estimated using the Bland-Altman method. Logistic regression was applied to estimate the risk of GFR <60 ml/min per 1.73 m2 as a result of the presence of abdominal obesity before and after adjustment for other covariates. Two-tailed comparisons were made throughout, and P < 0.05 was considered statistically significant. The analysis was carried out using SPSS for Windows (version 12.0; SPSS, Chicago, IL). 
