While the risk for developing ESRD after live kidney donation is minimal, when it does occur, Blacks, are disproportionately represented. The tree divides each internal node into two offspring nodes, which are determined by the values of one of the covariates and is intended to offer the "best possible" split, sending individuals to one offspring node or the other based on the imposed eGFR cut-off. Asian men should keep their waists no more than 35.5 inches and Asian women to no more than 31.5 inches, according to the Joslin Diabetes Center.

The reasons for that aren't totally clear, but it may have to do with having reserves to draw on when fighting off an illness. Diabetologia 48: 2486-2493. The resulting regression tree consists of nodes represented by circles and boxes. This process continues recursively, and the process stops itself when the finite number of individuals in the sample is exhausted. Psychoneuroimmunological Risk Factors in Renal Health and Disease was a cross-sectional study conducted by the National Minority Organ Tissue and Transplant Education Program (MOTTEP), a division of Howard University Hospital. "Back then, as a 14-year-old trying to learn everything by yourself, I didn't know that chart might not be for me.". Fortunately Tendai was able to get the operation she felt was so vital after losing weight. But as it turns out, BMI alone may not be the best way to size up your shape. This is present among donors who are overweight and severely obese, [10]. Other research identified older age at the time of donation as a potential risk factor for poorer renal function atrer donation in both Blacks and Caucasians [4]. Callender CO, Miles PV (2010) Minority organ donation: The Power of an educated Community. An illustration of the male CART is found in Figure 2. Your doctor can help decide if these further tests may be needed. "I have much more emphasis on the actual lifestyle, exercising and eating healthy," she says. View Figure 2. Hypertension 41: 625-633. Remaining ones must diversify, says Teddy Edwardes, The young women on a mission to reclaim the word 'pussy', Black people are more likely to be overweight than white people. https://www.cdc.gov/nchs/nhis/shs/tables.htm, Source: CDC 2019. Transplantation 74: 1349-1351. Our initial findings suggested that both BMI and WC were positively associated with glomerular hyper filtration, as indicated by GFR > 130. Fat stored in the stomach area is thought to be more dangerous than fat stored on the lower part of your body, such as your hips or thighs. "Their cholesterol and blood pressure are excellent. Sample mean age was 45 years; 48% were males. As a result, GFR and renal plasma flow rate increase. In particular, there is a gap in the literature that addresses the risk of ESRD among live kidney donors who are considered overweight and obese. One assertion states that the obesity induces intra-capillary glomerular pressure and glomerulosclerosis, thereby expanding the glomerular capillary surface area and changing arteriolar resistance [14]. Younger women were nearly 17 times more likely to have an eGFR > 130 than older women (OR = 16.567). Blacks have a greater need for kidney transplants than other American ethnic groups. Within the subset of females with BMI less than or equal to 34, age and BMI were significant predictors. Acta Endocrinol Suppl (Copenh) 242: 7-10. The first node is the root, consisting of the entire sample and the subsequent nodes consist of subsets of the sample. Similarly, obese live kidney donors were also more likely to have a decrease in GFR [20]. Above the age of 53, no men had an eGFR > 130; however, below this cut-off, all 23 men within this subset had an eGFR > 130, suggesting that younger age was more predictive of an eGFR > 130. ", Gambling addiction: 'A vicious cycle I couldn't get out of', Aspiring chef: 'Small or tall, I'm the same standard as everyone else in the kitchen', Conversations with Friends: 'Endometriosis plot might make someone visit GP', Peacock's Allan 'Seapa' Mustafa: 'People are being more open about body image issues', Every question you ever had about female ejaculation, answered, Five expert-approved break-up texts to send instead of ghosting. Their BMI shows up pretty high, and yet their body fat is actually pretty low," Kahan says. In the overall sample, BMI was positively associated with eGFR (r = 0.714; p < 0.01). This manuscript was made possible by Howard University's General Clinical Research Center grant #2MO1-RR010284 from the National Center for Research Resources (NCRR) a component of the National Institutes of Health (NIH) and its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. BMI-categorized obese women were nearly 40 times more likely to have an eGFR > 130 than their normal BMI counterparts (OR = 39.493). Their blood sugar is excellent. Black donors with obesity risk factors, when combined with GFR > 130 may be the factors placing overweight or obese AAs at increased risk for CKD after kidney donation. Palatini P (2012) Glomerular hyperfiltration: A marker of early renal damage in pre-diabetes and Pre-hypertension. -- Scott Kahan, MD. Among men, BMI overweight status did not increase the odds ratio (OR) of an eGFR > 130. Schmieder RE, Messerli FH, Garavaglia G, Nunez B (1990) Glomerular hyperfiltration indicates early target organ damage in essential hypertension. Your BMI doesn't reveal anything about the makeup of your body, such as how much muscle vs. fat you have. But the National Institute for Health and Care Excellence, which provides guidance for healthcare in England, has reported that the BMI cut-off points that determine if someone is overweight or obese are from previous studies of European-derived populations and may not be appropriate for other ethnic groups. BMI was calculated by dividing weight (kilograms) by height (square meters). When one looks at the rapidly accumulating data [26-28] that identifies how the organs received and donated by Black's are associated with statistically significant poorer survival rates; one has to answer "maybe so." For example, Asian-Americans tend to develop health risks, including the risk of diabetes, at lower BMIs than whites. Likewise, WC-categorized obese men and women had greater than 130 GFR. A move from BMI to waist-to-height ratio may give an individual a more accurate indication of where they are health-wise.

2019. WC-categorized obese men were nearly 16 times more likely to have an eGFR > 130 than their normal waist counterparts (OR = 15.989). The CART does not suggest that WC is an important predictor as the logistic regression did; however, it does suggest that SBP is predictive of eGFR, but this finding is not strong given its late appearance in the CART. Data Query: Table 7_2_1_6_1.2b [Accessed 03/03/2020] 2005 - 2022 WebMD LLC. BMI was categorized based on established cut-offs: 18.5 - 24.9 = normal weight; 25.0 - 29.9 = overweight; and greater than or equal to 30 = obese. Several mechanisms have been put forth in an attempt to explain the obesity-hyper filtration link. This finding was contrary to what has been suggested in other research. Further partitioning of this subset indicated that age was the next strongest predictor of an eGFR > 130 among female subjects with a BMI > 34, with 27 females less than or equal to age 57 having eGFR < 130. BMI is a quick way to measure whether you are a healthy weight, overweight or obese, calculated by dividing an adult's weight by the square of their height. For statistics on these related diseases, see: View Table 2, Table 3: Unadjusted associations between BMI, WC, eGFR, and explanatory variables. African American women have the highest rates of obesity or being overweight compared to other groups in the United States. Based on our findings, age was also significantly associated with hyper filtration. Clin J Am Soc Nephrol 2: 1215-1222. Factors that they identified as different in these Black donors have been increased creatinine clearances, increase blood pressures, and younger donor ages. It may be even more helpful than waist circumference alone, Kahan says. "BMI was created many, many years ago and it doesn't reflect our society as we see it today. "We do sometimes base health on certain parameters, such as BMI, so we can get an idea of how we can help our patients if they're at higher risk for certain diseases or health conditions. The inverse relationship between BMI and renal function has been seen in retrospective studies investigating renal health in live kidney donors after donation. Am J Transplant 11: 1650-1655. "Ultimately, they have similar risks as people who carry lots of body fat and have a high BMI.". To better understand the intricacies of our data, we utilized classification and regression trees (CART). According to NHS England, an ideal BMI is in the 18.5-24.9 range, anything between 25-29.9 is in the overweight range and a BMI between 30-39.9 would be classed as obese. Younger women were eight times as likely as older women to have an eGFR > 130 (OR = 8.180). Rodrique JR, Cornell DL, Lin JK, Kaplan B, Howard RJ (2007) Increasing live donor kidney transplantation: A randomized controlled trial of a home-based educational intervention. "When I would go to the doctor they used BMI to tell me if I was overweight or if I was at a healthy weight.". The risk for complications among morbidly obese individuals has been emphasized in the literature and may have substantial relevance for AA. America's Children: Key National Indicators of well-Being. Women should stick to no more than 35 inches. CART analysis identified a gender difference in these risk factors with males aged < 53 and WC > 105 having a strong association with eGFR > 130 and females aged < 57 and BMI > 34 being strongly associated with eGFR > 130. Navaneethan SD, Yehnert H, Moustarah F, Schreiber MJ, Schauer PR, et al. Self-reported data on hypertension and diabetes were provided by subjects based on a physician's previous diagnosis. ", Tendai looks back on her experience with her doctors and feels like there was some "injustice.". In Tendai's case, for a long time her BMI prevented her from getting surgery that she "would have gone through anything for," she says. Results indicate that increased BMI (> 30 kg/m2), increased waist circumference (> 40 inches) and increased GFR (> 130 ml/min) were strongly correlated in Black volunteers. For women, age was an important variable as well. (2005) Renal hyperfiltration in type 2 diabetes: Effect of age-related decline in glomerular filtration rate. Heart Disease See Heart Disease and African Americans

Although BMI is useful as a quick screening tool by a doctor or nurse, Kahan says, it's not enough to look at only that number. The purpose of this study was to determine if being overweight and obese were associated with glomerular hyper filtration (as defined by an eGFR > 130) in a non-patient sample of African Americans. Characteristics of the sample are found in Table 1. In the beginning, Scola says, "I used BMI very strictly to measure my progress and see how well I was doing and I remember getting so excited when I was getting a lower number on the BMI scale. (r = 0.67, p < 0.01 and r = 0.66, p < 0.01, respectively). Subjects were screened by phone and eligible for the study based on self-report of exclusion criteria. And Asians are considered obese at a BMI of 27 or higher, compared to the standard BMI obesity measure of 30 or higher. https://nccd.cdc.gov/youthonline. https://www.cdc.gov/nchs/data/hus/hus18.pdf [PDF | 1.56MB], Source: CDC 2020. Subjects were recruited through flyers posted at Howard University Hospital and advertisement at local health fairs. Richard L. Atkinson, MD, clinical professor of pathology, Virginia Commonwealth University; editor, International Journal of Obesity; president, Obetech Obesity Research Center in Richmond, Va. Scott Kahan, MD, MPH, director, National Center for Weight and Wellness, Washington, D.C.; faculty member, George Washington University School of Medicine; faculty member, Johns Hopkins University. The mean age of the subjects was 45.60 11.56 years. Trained graduate students administered a battery of psychological, neuropsychological, and social measures. Exclusion criteria for the community-based sample included current domestic and substance abuse, as well as, a previous diagnosis of a psychiatric disorder. The final partition in this subset was defined by a BMI > 29. Transplantation 84: 647-649. "At the time, I didn't know how to lose this weight. "I ended up looking at fad diets, thinking maybe if I stopped eating I would lose weight. JAMA 264: 2775-2780. Gibney EM, King AL, Maluf DG, Garg AX, Parikh CR (2007) Living kidney donors requiring transplantation: Focus on African Americans. In the past, transplant surgeons have rejected donors with low creatinine clearances < 80, hypertension, and with morbid obesity but have not considered an eGFR > 130 as a risk factor. But now she no longer feels like it's necessary. But if you're from India, your risk of diabetes starts going up with a BMI of about 21 or 22.". Waist size: For an accurate measurement, the tape measure should go around your waist at the top of your hip bones in your lower back and go around to the belly button. mean serum creatinine levels were 0.87 0.19 mg/dl and mean eGFR was 129.67 48.39 mL/min/1.73 m2. Ellie and Natasia: What is the history behind sketch comedy? After accounting for key health indicators, BMI overweight status did not increase the chances of an e\GFR >130 but BMI-obesity in men did. The study was conducted from 2004 to 2007 and utilized a convenience sample of 214 Black adults from the Washington, DC metropolitan area. View Table 3. Seven females with a BMI > 29 had an eGFR > 130 while 0 fell below the eGFR cut-off. Premaratne E, Macisaac RJ, Tsalamandris C, Panagiotopoulos S, Smith T, et al. Summary Health Statistics: National Health Interview Survey: 2018. Sex differences in WC cut-offs were utilized to stratify participants as non-obese or obese. Am J Transplant 11: 1650-1655. While this may not be a factor in other ethnic groups, in Black donors this may be a manifestation of hyper filtration, particularly when combined with the additional hyper filtration that occurs when one is left with one functional kidney. Future prospective studies therefore are necessary to better identify if Blacks are at greater risk for ESRD after live kidney donations. So what other tools can you use besides BMI?

https://www.cdc.gov/nchs/data/hus/hus18.pdf [PDF | 1.56MB], Source: Federal Interagency Forum on Child and Family Statistics. "They're heavy. https://www.childstats.gov/americaschildren/tables/health7.asp, Source: National Healthcare Quality and Disparities Reports. Among men, BMI and WC were significantly and positively associated with eGFR. ", National Institute of Child Health and Human Development: "Obesity and Overweight.". https://nhqrnet.ahrq.gov/inhqrdr/data/query, Source: CDC 2020. Tomaszewski M, Charchar FJ, Maric C, McClure J, Crawford L, et al. (2019) BMI, Waist Size, GFR: In African American Blacks. You've probably heard the term BMI (body mass index). She started documenting her weight loss journey on the platform from the age of 14 and previously used BMI as a way to measure her progress. J Am Coll Surg 210: 708-717. Ogden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of childhood and adult obesity in the United States, 2011-2012. Diabetes 51: 1572-1579. (2011) Ethnic and gender related difference in the risk of end stage disease after living kidney donation. Transplant Proc 40: 1337-1340. Their BMI can look in the normal range, even though they have quite a lot of body fat in comparison to their lean body mass," Kahan says. https://www.cdc.gov/nchs/nhis/shs/tables.htm, Source: National Healthcare Quality and Disparities Reports. A football player who is very muscular could have a high BMI and yet their body fat is actually low. Brenner BM, Lawler EV, Mackenzie HS (1996) The hyperfiltration theory: A paradigm shift in nephrology. Am J Kidney Dis 56: 303-312. Reeves-Daniel A, Adams PL, Daniel K, Assimos D, Westcott C, et al.