5. Renal Physiology in the Critically Ill Obese Patient

  1. Ali A. El Solh MD, MPH3,4,5
  1. Eric A. J. Hoste MD, PhD1 and
  2. Jan J. De Waele MD, PhD2

Published Online: 19 APR 2012

DOI: 10.1002/9781119962083.ch5

Critical Care Management of the Obese Patient

Critical Care Management of the Obese Patient

How to Cite

Hoste, E. A. J. and De Waele, J. J. (2012) Renal Physiology in the Critically Ill Obese Patient, in Critical Care Management of the Obese Patient (ed A. A. El Solh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119962083.ch5

Editor Information

  1. 3

    Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, USA

  2. 4

    Critical Care Western New York Healthcare System, USA

  3. 5

    Western New York Respiratory Research Center Buffalo, NY, USA

Author Information

  1. 1

    Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium

  2. 2

    Research Foundation, Flanders, Belgium

Publication History

  1. Published Online: 19 APR 2012
  2. Published Print: 16 APR 2012

ISBN Information

Print ISBN: 9780470655900

Online ISBN: 9781119962083



  • Acute kidney injury;
  • Glomerular filtration;
  • Creatinine clearance;
  • RIFLE classification;
  • Chronic kidney disease;
  • Intraabdominal pressure;
  • Intraabdominal hypertension;
  • Abdominal compartment syndrome;
  • Obesity paradox;
  • Epidemiology


Serum creatinine concentrations may over- or underestimate kidney function in critically ill obese patients. Assessment of kidney function by means of conventional equations can be misleading. Urinary creatinine clearance remains the most accurate diagnostic tool in this population. Obese patients have increased glomerular filtration rate and are predisposed to develop chronic kidney disease. Derangements in cardiovascular, metabolic, and respiratory systems place the critically ill morbidly obese patient at increased risk for acute kidney injury (AKI). In contrast to nonobese ICU patients in general, obese ICU patients who develop AKI have worse clinical outcomes.