title: Impact of morbid obesity on the kidney function of patients with type 2 diabetes.
abstract: OBJECTIVE
  Type 2 diabetes and obesity impair kidney function. We examined their respective contributions to urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in patients with type 2 diabetes and morbid obesity.
  
  
  METHODS
  Cross-sectional, monocentric study of kidney function in patients with type 2 diabetes classified into four body mass index (BMI) stages: non-obese (<25 kg/m(2), n=157); overweight (25 to <30, n=311); obesity (30 to <40, n=310); and morbid obesity (≥40, n=77), with 84 similarly staged controls without diabetes. UAE classes were defined as normal (<30 μg/mg creatinine), microalbuminuria (30-299), or macroalbuminuria (≥300) from 3 consecutive urine samples. GFR was measured by (51)Cr EDTA plasma disappearance (adjusted and unadjusted to 1.73 m(2) body surface area, as obesity increases body surface).
  
  
  RESULTS
  Participants with type 2 diabetes had same age, diabetes duration, and HbA1c across BMI stages. UAE was higher in participants with type 2 diabetes (p<0.0001), and increased with obesity stages (p<0.0001). After adjustment for age, sex, systolic blood pressure and type 2 diabetes status, morbid obesity was associated with a risk of microalbuminuria (OR 1.99, 95%CI 1.35-2.98, p=0.0007) and macroalbuminuria (OR 2.33, 95%CI 1.25-4.22, p=0.006). The body surface adjusted GFR was lower in patients with type 2 diabetes than in controls (p<0.0001), and declined with obesity stages, contrary to controls. An interaction of diabetes and obesity was seen with unadjusted GFR values (p=0.002).
  
  
  CONCLUSIONS
  Morbid obesity interacts with type 2 diabetes to aggravate UAE and GFR. Treatment strategies should focus on both conditions to protect kidney function in these patients.
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Narimène
authors: N
authors: Belhatem
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Kamel
authors: K
authors: Mohammedi
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Nuclear Medicine, Paris, France.
authors: François
authors: F
authors: Rouzet
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France.
authors: Nadia
authors: N
authors: Matallah
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France.
authors: Ahmed
authors: A
authors: Al Baloshi
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Florence
authors: F
authors: Travert
authors: INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Gilberto
authors: G
authors: Velho
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Ronan
authors: R
authors: Roussel
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Nuclear Medicine, Paris, France.
authors: Dominique
authors: D
authors: Le Guludec
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Michel
authors: M
authors: Marre
authors: Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Department of Endocrinology, Diabetology and Nutrition, Paris, France; INSERM, Research Unit 1138, Team 2 (Pathophysiology and Therapeutics of Vascular and Renal Diseases Related to Diabetes and Nutrition), Centre de Recherches des Cordeliers, Paris, France.
authors: Boris
authors: B
authors: Hansel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology*; D011446:Prospective Studies
keywords: Glomerular filtration rate; Kidney function; Obesity; Type 2 diabetes; Urinary albumin excretion