|Year : 2022 | Volume
| Issue : 2 | Page : 120-125
Evaluation of urea, creatinine levels, and proteinuria among obese individuals within abakaliki metropolis
Ugomma A Ude1, Michael E Kalu1, Chinenye L Ogbonna2, Victor U Usanga1, Simon O Azi1
1 Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Ebonyi State University, Abakaliki, Nigeria
2 Department of Laboratory Services, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
|Date of Submission||23-Dec-2021|
|Date of Decision||03-May-2022|
|Date of Acceptance||08-Jun-2022|
|Date of Web Publication||23-Nov-2022|
Michael E Kalu
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Ebonyi State University, Abakaliki
Source of Support: None, Conflict of Interest: None
Context: The deleterious effects of obesity on human health are systemic, and kidney dysfunction is now recognized as a health risk posed by obesity. Aim: The study was aimed at evaluating serum urea, creatinine levels, and proteinuria among obese individuals living in Abakaliki Metropolis. Settings and Design: This was a cross-sectional study of individuals living within Abakaliki Metropolis between August 2020 and September 2021. Materials and Methods: A total of 242 participants made up of 168 obese and 74 non-obese who consented to the study were recruited. Blood and urine samples were collected for the estimation of urea, creatinine levels, and proteinuria. Anthropometric data were collected using meter rule and digital scale for calculation of body mass index (BMI). Demographic data were collected using structured questionnaires. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using a digital sphygmomanometer under standard conditions. Statistical Analysis: The data generated were analyzed using Statistical Package for Social Sciences, version 20.0 (SPSS Inc. Chicago Illinois). Results: The results showed a higher BMI, SBP, DBP, urea, and creatinine levels in those with obesity than the non-obese. Females with obesity had non-significantly higher levels of urea and creatinine than males with obesity (P > 0.05). BMI, age, and SBP were observed to positively correlate with urea and creatinine levels among the obese. Participants in class II obesity had the highest urea level (6.37 ± 4.65) compared to other groups. Conclusion: A good control of weight helps to forestall progressive renal impairment.
Keywords: Anthropometry, creatinine, obesity, proteinuria, urea
|How to cite this article:|
Ude UA, Kalu ME, Ogbonna CL, Usanga VU, Azi SO. Evaluation of urea, creatinine levels, and proteinuria among obese individuals within abakaliki metropolis. Niger J Basic Clin Sci 2022;19:120-5
|How to cite this URL:|
Ude UA, Kalu ME, Ogbonna CL, Usanga VU, Azi SO. Evaluation of urea, creatinine levels, and proteinuria among obese individuals within abakaliki metropolis. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Dec 3];19:120-5. Available from: https://www.njbcs.net/text.asp?2022/19/2/120/361896
| Introduction|| |
Obesity and overweight are emerging major health problems in developing countries including Nigeria and other African countries, contributing to the burden of non-communicable diseases, and culminating in increase mortality and morbidity. Globally, the prevalence of obesity has been on the increase, which has necessitated the WHO global action plan to halt its rise and reduce its associated premature mortality by 25% by the year 2020.,
A major contributor to the increasing prevalence of obesity includes the preference for energy-dense food rich in fat to healthy nutritional diets. This is occasioned by economic growth, rapid urbanization, and a sedentary lifestyle. Obesity occurs as a result of a difference in calories consumed and calories expended, attributed to behavioral patterns, such as physical activity, dietary patterns, and use of medication. Obesity has been implicated in several conditions, including hypertension, diabetes mellitus, and dyslipidemia, as well as in renal impairment as in obesity-related glomerulopathy.,, Renal impairment is accompanied by increase serum urea and creatinine as well as the presence of protein in the urine, which are classic features of kidney disease.
The mechanism by which obesity interferes with renal function is not well understood, more confusing is the fact that the number of nephrons is neither increased nor decreased in the presence of obesity or weight gain in adults., However, based on recent literature, excessive weight gain raises renal plasma flow and increases single nephron perfusion because of compensatory hypertrophy of the individual nephrons, resulting in increased intraglomerular capillary pressure, glomerular hyperfiltration, and the triggering of the process that results in subsequent loss of glomerular filtration rate (GFR) over time. It has been reported that kidney weight increases with increased body weight. The autopsy report on the kidney of obese individuals in the absence of apparent renal disease or injury showed that the kidney of the obese weighed more than the age sex-matched control. Earlier studies revealed an increased renal volume but lower radiodensity in the obese when compared with non-obese suggesting accumulation of water. In the same study, total renal blood flow was higher in the obese than the non-obese. This could be explained by the increased stimulation and activity of the renal angiotensin aldosterone system with its consequential stimulation of sodium reabsorption in the proximal tubules culminating in systemic hypertension.
In Nigeria, about 12 million people are obese as of 2020 with a prevalence of 14.3%. Nevertheless, the prevalence of obesity in different parts of the countries is heterogeneous, increased in some regions and decreased in others.,, In Ebonyi State, an increased prevalence from 6.8% in 2013, 11.6% in 2020 to 11.1% in 2021 has been reported.,, Although there is a dearth of information on the prevalence of kidney impairment in Ebonyi State, its prevalence in Nigeria has increased from 7.8% in 2017 to 26% in 2018.,
Because of the increasing craves and adoption of western diet and lifestyle patterns by individuals in rural and urban areas of the states, the study was conducted to evaluate the serum urea, creatinine levels, and proteinuria among obese individuals within Abakaliki Metropolis, believing that early detection of kidney impairment will avert kidney disease.
| Materials and Methods|| |
Abakaliki is the capital of Ebonyi State, located in the Southeastern part of Nigeria. The inhabitants of the area are mostly Igbo-speaking people who are predominantly farmers, traders, and civil servants. They are leading producers of food, such as rice, yam, cassava, potatoes among others.
Study design and study population
The study was a cross-sectional and control–case study carried out among individuals living within Abakaliki Metropolis. The participants made up of males and females within the ages of 18–80 years were selected by simple random sampling. Participants who admitted having renal dysfunction in the questionnaires and those on medications were excluded from the study. The study was carried out between August 2020 and September 2021. A total of 242 participants made up of 168 obese and 74 age and sex-matched non-obese as control who consented to the study were recruited for the study.
A meter rule to the nearest 0.1 cm and a digital scale to the nearest 0.1 kg were used for height and body weight measurements, respectively. A flexible tape rule to the nearest 0.1 cm was used to measure the waist circumference at the level of the superior iliac crest at the end of normal expiration and hip circumference. Body mass index (BMI) was calculated as weight in kilogram divided by the square of height in meter using the Quartlet forumula. Waist-hip-circumference was calculated as waist circumference divided by hip circumference. Based on their BMI, participants were grouped into underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), and Obese (>29.9). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in the right arm, in a sitting position, using a digital sphygmomanometer with appropriate cuff size, and under standard conditions in repeated measurement. Participants were grouped according to their BP as normal (SBP <120, DBP <80), prehypertension (SBP 120–139, DBP 80–89), stage-I hypertension (SBP 140–159, DBP 90–99), and stage-II hypertension (SBP ≥160, DBP ≥100).
Serum levels of urea and creatinine were estimated following the methods and instructions in the commercial kits obtained from RANDOX Laboratories Ltd., Crumlin, Antrim, UK. Proteinuria was determined with the use of Albustix from Skytec Inc., USA.
This study was approved by the Ethical Research Committee of the Faculty of Health Sciences and Technology, Ebonyi State University (EBSU/FHST/MLS/2021/041), and all the participants gave their consent before being recruited in the study. All ethical precepts regarding research on humans were duly followed.
The data generated in this study were analyzed using Statistical Package for Social Sciences, version 20.0 (SPSS Inc. Chicago Illinois). Results were presented in mean ± standard deviation. Variable were compared with Student's t-test, ANOVA, and Pearson's Chi-square. Significant P value was taken as <0.05.
| Results|| |
Effect of obesity on renal function
As shown in [Table 1], the obese were older, had a higher BMI, SBP, and DBP than the non-obese. The serum urea and creatinine of the obese were higher than those of the non-obese. The difference in age, DBP, urea, and creatinine between the obese and non-obese were not statistically significant (P = 0.159, P = 0.076, P = 0.772, and P = 0.345, respectively), whereas the difference in BMI and SBP between the obese and non-obese were statistically significant (P = 0.000 and P = 0.009, respectively). The association between obesity and proteinuria was not statistically significant (P = 0.483).
Sex-related difference of serum urea and creatinine among the obese
As shown in [Table 2], males had not a significantly higher serum urea and creatinine level (3.04 ± 121 and 1.162 ± 0.39) than the females (3.21 ± 2.52 and 1.29 ± 0.78) (P = 0.800, P = 0.051). The association between sex and proteinuria was not statistically significant (P = 0.486).
BMI-related difference of serum urea and creatinine among the obese
The class II obese participants had the highest serum urea level (6.37 ± 4.65) and the least serum creatinine level (1.21 ± 0.63), whereas the class III obese participants had the least serum urea level (1.55 ± 0.95) and the highest serum creatinine level (1.61 ± 0.84). The difference in serum urea between and within the groups of obesity was statistically significant (P = 0.000), whereas that of the serum creatinine was statistically not significant (P = 0.597). The association between BMI and proteinuria was statistically significant (P = 0.002) [Table 3].
|Table 3: Comparative analysis of BMI-related difference of urea and creatinine among the obese|
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Age-related difference of serum urea and creatinine among the obese
[Table 4] shows the comparative analysis of age differences among the obese and their effect on renal function. Participants aged between 50 and 70 years had the highest serum urea and creatinine level (3.63 ± 3.14 and 1.71 ± 0.81, respectively), whereas those in the age group ≥70 years had the least serum urea level (2.37 ± 1.02) and those ≤30 years had the least serum creatinine level (1.17 ± 0.57). The difference in serum urea and creatinine between and within the various age groups was statistically not significant (P = 0.658 and P = 0.057, respectively). The association between age and proteinuria was not statistically significant (P = 0.061).
|Table 4: Comparative analysis of Age-related difference of urea and creatinine among the obese|
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Blood pressure-related difference of serum urea and creatinine among the obese
As shown in [Table 5], participants in stage-II hypertension had the highest serum urea level (5.65 ± 5.48), whereas the pre-hypertensive participants had the least serum urea level (2.30 ± 1.16) and the highest serum creatinine level (1.46 ± 0.76), and those in stage-I hypertension had the least serum creatinine level (1.14 ± 0.68). The difference in serum urea and creatinine level among the various groups of blood pressure was statistically not significant (P = 0.061 and 0.931, respectively). A statistically significant association was observed between blood pressure and proteinuria (P = 0.045).
|Table 5: Comparative analysis of blood pressure-related difference of urea and creatinine among the obese|
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Bivariate correlation between BMI, Age, Blood pressure, and urea and creatinine
Based on Pearson's bivariate correlation as shown in [Table 6], a negative correlation was observed between BMI and urea (r = –0.092) as well as between BMI and creatinine (r = –0.036). Age correlates positively with urea (r = 0.026) and creatinine (r = 0.402) and SBP correlates positively with urea (r = 0.017) and creatinine (r = 0.150). DBP correlates positively with urea (r = 0.108) and negatively with creatinine (–0.216).
|Table 6: Pearson's bivariate correlation between variables and urea and creatinine|
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| Discussion|| |
In the present study, BMI and SBP were observed to be significantly higher in the obese when compared to the non-obese (P < 0.05). Also, DBP, urea, and creatinine were higher in the obese than the non-obese. However, the difference was not statistically significant (P > 0.05). These findings corroborate with the report of Ray et al. that reported a BMI of 28.00 ± 2.05, serum urea of 48.03 ± 4.74 mg/dl, and creatinine of 1.10 ± 0.21 mg/dl in the obese against 21.14 ± 1.31, 35.1 ± 4.42 mg/dl, and 0.82 ± 0.10, respectively in the non-obese in India. The findings of this study also agree with the findings of Manahil et al. who reported higher serum urea and creatinine level in the obese. Ozlem et al. also reported a higher SBP, DBP, and BMI in the obese than the non-obese.
More obese females participated in this study with not significantly higher serum urea and creatinine levels when compared with the male counterpart (P > 0.05). These findings disagree with that of Sabiullah who reported that serum urea and creatinine concentrations significantly differ according to gender. It also disagrees with the general notion that men exhibit a higher risk of kidney disease and develop the disease earlier in life than women because of hormonal and lifestyle influences. The higher serum urea and creatinine among the females as observed in this study could be because of reduced physical activities by the women in the area of studies, leading to increased BMI and consequently increased creatinine.
A positive correlation was observed in this study between BMI and urea as well as between BMI and creatinine. However, the difference in serum urea level between the classes of obesity was statistically significant (P ≤ 0.05), whereas the difference in creatinine was not statistically significant (P > 0.05). The study also observed a strong association between BMI and proteinuria. The higher urea and creatinine level in the class III obese group than other groups agree with the trend in other studies that urea and creatinine increase with increasing BMI., Hobbs et al. reported that there is no relationship between BMI and serum urea and creatinine. The findings of this study agree with the study of Sabiullah that reported a statistically significant negative correlation between estimated GFR and BMI, suggesting that BMI leads to renal dysfunction. Estimated GFR is inversely proportional to creatinine and is calculated from modification of diet in renal disease equation. The difference between the findings of this study and other studies could be different criteria for the selection of participants.
As BMI does not distinguish muscle from fat, it has limitations as a measure of obesity. It is worth noting that although BMI is the most widely used measure of adiposity, it may not be ideal because of its inability to reliably distinguish visceral obesity from subcutaneous fat nor is it able to differentiate a high body weight because of muscle mass from fat. Irrespective of the limitations that abound in the use of BMI in determining obesity, its association with visceral fat has been outstanding and greatly exploited.
Proteinuria was found higher in the obese class III group compared to other groups and progressively raised with increasing BMI. The strong association between BMI and proteinuria reported in this study by the dipstick method is consistent with the other studies that reported a link between higher BMI and albuminuria., Robert et al. reported that BMI strongly associates with both albuminuria and proteinuria. Induced cytopathological effects on the kidney such as alteration in podocyte structure, as well as the release of cytokines and glomerular capillary hypertension, have been suggested as a possible mechanism underlying obesity-related renal impairment.
Possible mechanisms by which obesity could cause proteinuria include alteration in podocyte structure or function, glomerular capillary hypertension, and adipocyte-derived cytokines. The latter has been purported to increase glomerular capillary permeability to proteins and enhance renal fibrosis.
Concerning Age, this study observed a positive correlation between age and serum urea and creatinine. Although those ≥70 years had the least urea level, those in the age group 31–50 years had the least creatinine level. The study also reported a non-significant association between age and proteinuria. In this study, age was observed to positively correlate with urea and creatinine level. This finding is in accordance with the fact that serum urea and creatinine are established markers of GFR. Serum creatinine is a more sensitive index of kidney function compared to serum urea level. This is attributed to the fact that the level of creatinine in urine is less influenced than urea. Currently, creatinine-based GFR estimation remains the method of choice for the evaluation of kidney function routinely in clinics. Physiological phenomenon including decrease glomerular volume, glomerular sclerosis, increase glomerular permeability, and decrease number of nephrons accompanying ageing are also contributing factors. Ageing is also a risk predictor for outcomes in chronic kidney disease. In the study of Chen et al. conducted in chronic kidney disease patients, the risk of death was higher in the aged than the young concerning their GFR. The observation that obesity in older ages (≥50 years) were associated with higher values of creatinine and urea increasing the risk of progressive loss of kidney function is supported by the findings of this study.
SBP positively correlated with urea and creatinine in this study, whereas DBP correlated positively with urea and negatively with creatinine. This is in line with the report of Seong et al. that serum creatinine positively correlates with SBP and DBP at baseline. The association between obesity and hypertension as observed in this study is in line with an established report. Wu et al. stated that hypertension risk increases with increased BMI and that irrespective of gender difference, BMI is a distinctive risk factor for hypertension. Visceral obesity may increase blood pressure, in part, through physical compression of the kidneys and this may be an important mechanism by which obesity causes hypertension. In addition to the potential compressive force of visceral and perinephric fat on the kidneys, the accumulation of fat in the renal sinuses has been associated with stage-II hypertension in the elderly.
| Conclusion|| |
The rise in obesity prevalence worldwide poses important questions on how to assess kidney function in obese individuals. This study confirmed the nephropathologic effect of obesity. The average serum urea, creatinine, SDP, and DBP were higher in the obese than the non-obese, and BMI, age, and SBP correlates positively with urea and creatinine. Good control of BMI helps to prevent progressive renal impairment. To prevent the progression of renal impairment in obesity, serum urea and creatinine, as well as proteinuria, should form part of a routine checkup.
The authors wish to acknowledge and appreciate the staff of Ebonyi State University Ultramodern Diagnostic and Research Laboratory.
The concept of the study, writing of original draft, and methodology were by Ugomma A. Ude. Methodology, investigation, and formal analysis were performed by Michael E. Kalu. Chinenye L. Ogbonna carried out investigation. Victor U. Usanga and Simon O. Azi reviewed and edited the manuscript and supervised the study. All the authors reviewed and approved the final submission and publication.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]