Obesity and Kidney Disease: What is the Connection?
The month of January has forever been the month of resolutions with many choosing to ditch the sweets and join the gym. However, for many these efforts are limited to January and bad habits are quick to remerge. Obesity has been a burden on the health service for many years with the problem, like many people’s waist lines, only continuing to expand.
Recent findings have shown that this problem is no longer just increasing in developed countries but also in developing countries. In fact, worldwide obesity has tripled since 1975. In 2016, more than 1.9 million adults were classed as overweight, of which over 650 million were obese.1 These are shocking statistics for a condition that is preventable. As a global concern, it is important to assess all the potential risks of this problem.
The most common diseases associated with obesity are cardiovascular disease (CVD) and diabetes. However, the associated risks are much greater than this. Being overweight may also increase the risk of certain types of cancer, sleep apnea, osteoarthritis, fatty liver disease and kidney disease.2
Obesity is now recognised as a potent risk factor for the development of renal disease.3 Excess weight has a direct impact on the development and progression of chronic kidney disease (CKD). Globally, the prevalence of diabetic kidney disease rose by 39.5% between 2005 and 2015, coinciding with the increased CKD prevalence.4 In obese individuals, the kidneys have to work harder, filtering more blood than normal to meet the metabolic demands of increased body weight, increasing the risk of kidney disease.
The traditional diagnostic test for renal impairment is creatinine. This test is carried out through the measurement of creatinine levels in the blood to assess the kidneys ability to clear creatinine from the body. This is called the creatinine clearance rate which helps to estimate the glomerular filtration rate (GFR), which is the rate of blood flow through the kidneys.5
Problems arise when using creatinine for CKD testing as a number of factors need to be taken into consideration including age, gender, ethnicity and muscle mass. For this reason, black men and women exhibit higher creatinine levels than white men and women, raising concern over the accuracy of this test for certain patient groups.6 In addition, serum creatinine is not an adequate screening test for renal impairment in the elderly due to their decreased muscle mass.7
The main disadvantage of using creatinine to screen for renal impairment is that up to 50% of renal function can be lost before significant creatinine levels become detectable as creatinine is insensitive to small changes in GFR. Consequently, treatment is not provided at the appropriate time which can be fatal, therefore, an earlier and more sensitive marker for renal function is vital.8
These disadvantages have not only been highlighted in research but also by the national institute for health and care excellence (NICE). NICE updated the classification of CKD in 2004 to include the albumin: creatinine ratio (ACR). They split chronic kidney disease patients into categories based on GFR and ACR. Figure 1 highlights the different categories and risk of adverse outcomes. NICE recommend using eGFR Cystatin C for people in the CKD G3aA1 and higher.9
Figure 1 Classification of Chronic Kidney Disease using GFR and ACR categories.9
Despite these suggestions, Creatinine is still being used for G3a1 and increasing risk levels.
The utility of cystatin C as a diagnostic biomarker for kidney disease has been documented to show superiority of traditional CKD tests. There is no ‘blind area’ making it very sensitive to small changes in GFR and capable of detecting early reductions. Furthermore, this marker is less influenced by diet or muscle mass and has proven to be a beneficial test in patients who are overweight.8
A number of studies support the statement: ‘Cystatin C levels are higher in overweight and obese patients’. This is important because when cystatin c levels are too high, it may suggest that the kidneys are not functioning properly. One study conducted, using a nationally representative sample of participants, found that overweight and obesity maintained a strong association with elevated serum cystatin C. This suggests that weight can affect the levels of cystatin C and therefore the likelihood of developing kidney disease.10
How Randox can Help
The Randox automated Latex Enhanced Immunoturbidimetric Cystatin C tests offers an improved method for assessing CKD risk, combined with a convenient format for routine clinical use, for the early assessment of at risk patients. Randox is currently one of the only diagnostic manufacturers who offer an automated biochemistry test for Cystatin C measurement, worldwide.
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- World Health Organization. Obesity and Overweight . int. [Online] WHO. [Cited: January 22, 2019.] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
- Health Risks of Being Overweight. NIDDK. [Online] National Institute of Diabetes and Digestive and Kidney Diseases. [Cited: March 24, 2019.] https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight.
- Kidney Health Australia . Obesity and Chronic Kidney Disease: The Hidden Impact. Kidney Health Week/ World Kidney Day 2017. [Online] Kidney Health Australia. [Cited: January 22, 2019.] https://kidney.org.au/cms_uploads/docs/kidney-health-australia-report-obesity-and-chronic-kidney-disease–the-hidden-impact_06.03.17.pdf.
- Neuen, Brendon Lange, et al. Chronic kidney disease and the global NCDs agenda. s.l. : BMJ Global Health, 2017
- Creatinine and Creatinine Clearance Blood Tests. WebMD. [Online] WebMD. [Cited: January 22, 2019.] https://www.webmd.com/a-to-z-guides/creatinine-and-creatinine-clearance-blood-tests#1.
- Lascano, Martin E and Poggio, Emilio D. Kidney Function Assessment by Creatinine-Based Estimation Equations. Cleveland Clinic. [Online] August 2010. [Cited: 16 May 2018.] http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/kidneyfunction/.
- Swedko, Peter J, et al. Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients. Research Gate. [Online] February 2003. [Cited: 6 May 2018.] https://www.researchgate.net/publication/8243393_Serum_Creatinine_Is_an_Inadequate_ Screening_Test_for_Renal_Failure_in_Elderly_Patients.
- Mishra, Umashankar. New technique developed to detect chronic kidney disease. Business Line. [Online] 07 May 2018. [Cited: 17 May 2018.] https://www.thehindubusinessline.com/news/science/new-technique-to-detect-chronic-kidney-disease/article23803316.ece.
- National Institute for Health and Care Excellence. Chronic kidney disease in adults: assessment and management: 1 Recommendations. National Institute for Health and Care Excellence. [Online] January 2015. https://www.nice.org.uk/guidance/cg182/chapter/1- recommendations#classification-of-chronic-kidney-disease-2.
- Overweight and Obesity and Elevated Serum Cystatin C Levels in US Adults . Muntner, Paul, et al. 4, s.l. : NCBI, 2008, Vol. 121.
Earlier this year the World Obesity Federation made the stark statement that: “The early diagnosis and treatment of childhood obesity could be considered similar to vaccination.”
Essentially, they want to see this condition treated in the same way as chicken pox, measles and mumps: tackled – in the hope of eradication – by a strategic approach founded on proactive policies and early prevention.
Obesity in children and adolescents has risen tenfold in the last 40 years, according to a recent study by The Lancet. In Britain, one in ten young people aged between 5 and 19 is obese. Worryingly, the prevalence of obesity is actually higher in younger children than older ones.
The WHO first called for obesity to be understood as a disease in 1948, but back then it wasn’t even considered a risk factor for cardiovascular disease. In 1997 the WHO held a special conference on obesity and stated that: “the global epidemic projections for the next decade are so serious that public health action is urgently required.”
Then it was alarmed that the prevalence of men with a BMI greater than 30 was 15% and 16.5% in women. To think that it has now risen dramatically to 67% for men and 57% for women, highlights just how serious a problem obesity poses to society.
The calls for more countries to officially recognise it as a disease is based on the position that obesity meets the definition of a chronic, relapsing, progressive disease that causes organ damage.
Women and men who are obese are 12.5 and 5.2 times (respectively) more likely to develop diabetes than people who are a healthy weight. 90% of people with Type 2 diabetes are obese.
People with diabetes are then at a greater risk of a range of chronic health conditions including cardiovascular disease, blindness, amputation, kidney disease and depression than people without diabetes. Diabetes leads to a two-fold excess risk for cardiovascular disease, and diabetic retinopathy is the leading cause of preventable sight loss among people of working age in England and Wales. About one in twenty people have diabetes, yet people with diabetes account for one quarter to one third of hospital admissions for cardiovascular disease.
According to Government figures released this year, people who have Type 2 diabetes are 28.4% more likely to die early than their peers.
Getting in front of this wave of diabetes will not only bring down the numbers of people affected but also see a positive impact on the numbers of obese people. As with all conditions – the earlier they are identified, the better. To do this, new methods of diagnosis are being developed.
A radical new test for a protein found in our blood called adiponectin can identify pre-diabetes. This is a game-changing diagnostic tool that empowers people with the knowledge that they are at risk, but may be able to avoid it through relatively simple lifestyle changes.
The adiponectin test is available from Randox – both for clinical use and also through our Randox Health clinics. We have developed the most comprehensive health checks available on the market. These are so sensitive that in a range of conditions including diabetes we are able to identify signs of pre-illness. This enables clients to make often simple changes to stay healthy.
We know that prevention works. The NHS carried out a study in 2016 which revealed an average 26% reduction in new cases of Type 2 diabetes in those participating in a diabetes prevention programme, compared with usual care.
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Obesity is a condition where a person has abnormal or excessive fat accumulation that presents a serious risk to health. This December, Randox are highlighting the health implications of this potentially deadly condition, especially throughout the midst of this festive season when it is all too easy to overindulge in fatty foods and sugary treats!
Worldwide obesity has almost tripled between 1975 and 2016, with over 650 million adults and 340 million children being recorded as obese in 2016 alone, highlighting that the prevalence of the condition is rapidly rising. Randox are dedicated to improving health and increasing the awareness and prevention of obesity and its consequences.
What are the causes and consequences of obesity?
With more people around the world adopting sedentary lifestyles and the increasing consumption of foods high in sugar and fat, there is a higher risk of an energy imbalance between calories consumed and calories expended, which is the fundamental cause of obesity. This increases the risk of a number of diseases such as cardiovascular disease, diabetes, musculoskeletal disease and some forms of cancer, with each condition having detrimental effects to your health.
One of the more serious consequences of obesity is type 2 diabetes mellitus (T2DM), where a resistance to insulin is developed causing blood sugar to rise higher than normal. This can lead to serious, long-term problems such as kidney damage, cardiovascular disease and blindness.
How are Randox supporting the battle against the world’s obesity crisis?
Through extensive investment in R&D, we are able to offer cutting-edge diagnostic tests to assess the risk of obesity-related diseases before they occur!
Randox offers the unique adiponectin test to assess the risk of developing T2DM. Low adiponectin levels have also been linked with the risk of developing other pathologies including metabolic syndrome and cardiovascular diseases. The adiponectin test is applicable to both patients with diagnosed clinical obesity, and those deemed to have a ‘healthy’ BMI through a condition known as ‘abdominal obesity’.
This is because while it is widely recognised that people who are overweight or obese are at higher risk of developing T2DM, you don’t have to be overweight to be at risk of developing diabetes. When abdominal visceral fat is stored further underneath the skin and accumulates around major organs, a condition known as abdominal obesity, it greatly increases the risk of developing T2DM. When abdominal visceral fat levels become increased, adipocytes which secrete the protein hormone adiponectin become reduced; this reduces the anti-inflammatory and insulin-sensitising properties of this powerful hormone.
The adiponectin test is available for use on hundreds of clinical biochemistry analysers, and can also be run on our world leading RX series range of clinical chemistry analysers. Find out more here: www.randox.com/obesity/
Our world-renowned quality control products help ensure the accuracy of obesity-related testing!
When diagnosing and monitoring obesity-related complications such as cardiovascular disease (CVD) and T2DM, it is vital that laboratories have a robust quality control system in place to ensure the accuracy and reliability of the results produced. This is especially true considering, 70% of medical decisions are based on a laboratory test result.
It is estimated that over 90% of T2DM is related to obesity. When monitoring diabetes, glycated haemoglobin (HbA1c) levels in the blood provide an indication of average blood glucose levels for the previous 3 months. It is therefore important that the chosen quality control will effectively challenge the test system across the patient reportable range, as an inaccurate result at the cut-off could mean a patient does not receive appropriate diabetes treatment. Our Acusera Liquid HbA1c control provides clinically relevant levels, not only helping to ensure accurate instrument performance but maximising laboratory efficiency. Find out more here: www.randox.com/obesity/
Thankfully, for those deemed to be at risk, obesity and related illnesses are largely preventable through engaging in regular physical activity (60 minutes daily recommended for adults), limiting energy intake from total fats and sugars and increasing the consumption of fruit and veg, whole grains and nuts. Knowing your risk allows you to stay in control of your health throughout this festive season!
Further to our clinical lab tests, our Randox Health clinics offer heart health, metabolic health and diabetes health testing as part of our Everyman, Everywoman and Signature packages to identify and assess risk of developing obesity-related diseases. Our clinics utilise the same cutting-edge tests and quality control that we have available to clinical laboratories globally, as well as our patented Biochip Array Technology (BAT).
For more information about our clinical diagnostic range of obesity-related products, visit www.randox.com/obesity/
On 9 March 2017, Randox Reagents are celebrating World Kidney Day! World Kidney Day is a global campaign aimed at raising awareness of the importance of our kidneys to our overall health. It aims to reduce the frequency and impact of kidney disease and its associated health problems worldwide.
This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviours an affordable option.
With this in mind, throughout the week we have been sharing on social media some interesting facts on diagnostic tests which can help aid an early risk assessment of kidney disease in obese patients, allowing preventative action to be taken before any serious damage occurs. The tests of focus this week included cystatin C, adiponectin and microalbumin…
The creatinine test is routinely run for patients who are suspected for deteriorating kidney function, however this test has limitations. Cystatin C is an alternative test, and is particularly useful in patients where creatinine measurements are not suitable e.g. individuals who are obese, malnourished, have liver cirrhosis or reduced muscle mass. Importantly, unlike creatinine, cystatin C does not have a ‘blind area’ – up to 50% of kidney function can be lost before significant creatinine elevation occurs. Cystatin C is extremely sensitive to very small changes in kidney function and is therefore capable of detecting early stage kidney dysfunction. The cystatin C test therefore allows preventative measures to be taken much earlier and before significant kidney function decline.
There is substantial evidence that excess visceral fat is the main driving force for almost all of the disorders associated with the metabolic syndrome, including CKD.1,2 The adiponectin test from Randox can accurately assess levels of abdominal visceral fat, independent of age, race or fitness level.3,4 Assessing adiponectin, and therefore visceral fat levels, can help assess risk of CKD, as well as a range of other illnesses such as pre-diabetes, CVD and various cancers.
The microalbumin test detects very low levels of a blood protein called albumin, in urine. The detection of albumin in urine can be an indicator of kidney injury and can result in irreversible damage if left untreated. Low albumin concentrations in the urine are the earliest marker of kidney damage and therefore enable preventative measures to be taken. Microalbumin testing can identify individuals with diabetic nephropathy approximately 5-10 years earlier than proteinuria tests helping reduce the frequency of end stage renal disease.
Both World Kidney Day and Randox are working towards improving healthcare worldwide. With continuous investment in R&D, Randox are helping with the risk assessment and earliest detection of renal function problems. By assessing one’s risk of kidney problems (with the adiponectin test), it can give patients (obese and other) the tools to prevent kidney problems further on down the line. With early diagnosis (through the cystatin C and microalbumin tests) it will be possible to keep kidney problems from getting worse, therefore lowering the number of those diagnosed with CKD worldwide.