Obesity is known to be associated with a myriad of cardiovascular and metabolic comorbidities. In children, several longitudinal studies have shown that obesity consequences start early in life and accompany the obese child into adulthood, implying a higher risk of adverse cardiovascular events. More recently, data related to the possible role of obesity in the risk of kidney disease in adults, independently of diabetes, has started to become more available. In children, the evidence is scarcer, but it has also been acknowledged that obesity acts as a risk factor for disease progression when kidney impairment already exists, thereby increasing the risk of death among children with end-stage renal disease (ESRD). Besides this, there is also evidence that otherwise healthy overweight and obese children have a significant increase in the risk of all-cause ESRD later in life. The potential mechanisms underlying this association need to be further discussed in order to allow the setting in motion of preventive strategies to halt chronic kidney disease development and progression.

1.
GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, et al: Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377: 13–27.
2.
Cohen AH: Massive obesity and the kidney. A morphologic and statistical study. Am J Pathol 1975; 81: 117–130.
3.
Kalaitzidis RG, Siamopoulos KC: The role of obesity in kidney disease: recent findings and potential mechanisms. Int Urol Nephrol 2011; 43: 771–784.
4.
Garofalo C, Borrelli S, Minutolo R, Chiodini P, De Nicola L, Conte G: A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int 2017; 91: 1224–1235.
5.
Postorino M, Marino C, Tripepi G, Zoccali C; CREDIT (Calabria Registry of Dialysis and Transplantation) Working Group: Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol 2009; 53: 1265–1272.
6.
Meier-Kriesche H-U, Arndorfer JA, Kaplan B: The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation 2002; 73: 70–74.
7.
Savino A, Pelliccia P, Chiarelli F, Mohn A: Obesity-related renal injury in childhood. Horm Res Paediatr 2010; 73: 303–311.
8.
Wahba IM, Mak RH: Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol 2007; 2: 550–562.
9.
Pantoja Zuzuarregui JR, Mallios R, Murphy J: The effect of obesity on kidney length in a healthy pediatric population. Pediatr Nephrol 2009; 24: 2023–2027.
10.
Filler G, Reimão SM, Kathiravelu A, Grimmer J, Feber J, Drukker A: Pediatric nephrology patients are overweight: 20 years’ experience in a single Canadian tertiary pediatric nephrology clinic. Int Urol Nephrol 2007; 39: 1235–1240.
11.
Bonthuis M, van Stralen KJ, Verrina E, Groothoff JW, Alonso Melgar Á, Edefonti A, Fischbach M, Mendes P, Molchanova EA, Paripović D, Peco-Antic A, Printza N, Rees L, Rubik J, Stefanidis CJ, Sinha MD, Zagożdżon I, Jager KJ, Schaefer F: Underweight, overweight and obesity in paediatric dialysis and renal transplant patients. Nephrol Dial Transpl 2013; 28(suppl 4):iv195–iv204.
12.
Wong CS, Gipson DS, Gillen DL, Emerson S, Koepsell T, Sherrard DJ, Watkins SL, Stehman-Breen C: Anthropometric measures and risk of death in children with end-stage renal disease. Am J Kidney Dis 2000; 36: 811–819.
13.
Mitsnefes MM, Khoury P, McEnery PT: Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 2002; 17: 535–539.
14.
Ku E, Glidden DV, Hsu CY, Portale AA, Grimes B, Johansen KL: Association of body mass index with patient-centered outcomes in children with ESRD. J Am Soc Nephrol 2016; 27: 551–558.
15.
Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, Calderon-Margalit R: Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Intern Med 2012; 172: 1644–1650.
16.
Silverwood RJ, Pierce M, Hardy R, Thomas C, Ferro C, Savage C, Sattar N, Kuh D, Nitsch D: Early-life overweight trajectory and CKD in the 1946 British birth cohort study. Am J Kidney Dis 2013; 62: 276–284.
17.
Abitbol CL, Chandar J, Rodríguez MM, Berho M, Seeherunvong W, Freundlich M, Zilleruelo G: Obesity and preterm birth: additive risks in the progression of kidney disease in children. Pediatr Nephrol 2009; 24: 1363–1370.
18.
Cignarelli M, Lamacchia O: Obesity and kidney disease. Nutr Metab Cardiovasc Dis 2007; 17: 757–762.
19.
Ritz E, Amann K, Koleganova N, Benz K: Prenatal programming-effects on blood pressure and renal function. Nat Rev Nephrol 2011; 7: 137–144.
20.
I’Allemand D, Wiegand S, Reinehr T, Müller J, Wabitsch M, Widhalm K, Holl R: Cardiovascular risk in 26,008 European overweight children as established by a multicenter database. Obes (Silver Spring) 2008; 16: 1672–1679.
21.
Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U: Glomerular hemodynamics in severe obesity. Am J Physiol Ren Physiol 2000; 278:F817–F822.
22.
Mathew AV, Okada S, Sharma K: Obesity related kidney disease. Curr Diabetes Rev 2011; 7: 41–49.
23.
Correia-Costa L, Schaefer F, Afonso AC, Bustorff M, Guimarães JT, Guerra A, Barros H, Azevedo A: Normalization of glomerular filtration rate in obese children. Pediatr Nephrol 2016; 31: 1321–1328.
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