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Guo Q, Wang Y, Liu Y, Wang Y, Deng L, Liao L, Lin X, Wu M, Sun M, Liao Y. Association between the cardiometabolic index and chronic kidney disease: a cross-sectional study. Int Urol Nephrol 2024; 56:1733-1741. [PMID: 38063958 PMCID: PMC11001751 DOI: 10.1007/s11255-023-03888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND Central obesity is a risk factor for chronic kidney disease (CKD). However, the exact correlation between the cardiometabolic index (CMI), an indicator of central obesity, and CKD remains unclear. Here, we aimed to investigate the correlation between the CMI and CKD in the general American population. METHODS This cross-sectional study involved 64,313 members of the general population (≥ 20 years of age) with data in the National Health and Nutrition Examination Survey (NHANES) 1999-2020. The individuals were grouped into three categories by CMI tertile: T1 group (n = 7,029), T2 group (n = 7,356), and T3 group (n = 7,380). Logistic regression analysis was performed, with NHANES recommended weights, to assess the association between the CMI and CKD. RESULTS A total of 21,765 participants were included; the overall prevalence of CKD was 12.2%. From the low to the high CMI tertile, the prevalence of CKD increased from 8.9% to 16.0% (P < 0.001). After full adjustment for confounders, the higher tertile of CMI (OR: 1.08, 95% CI: 1.03 - 1.13, P = 0.002) had the higher risk of CKD. Compared with the T1 group, the groups with higher CMI levels had a higher CKD risk (T2: OR: 1.01, 95%CI: 0.87-1.18, P = 0.812; T3: OR: 1.22, 95%CI: 1.05-1.43, P = 0.013). CONCLUSIONS Higher CMI was independently associated with higher CKD risk in the general population.
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Affiliation(s)
- Qian Guo
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Yani Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Yuchen Liu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Yun Wang
- Department of Electrocardiography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Lin Deng
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Lihua Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Xueqin Lin
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Mingxin Wu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Meirui Sun
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, China.
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Westenberg LB, Pol RA, van der Weijden J, de Borst MH, Bakker SJ, van Londen M. Central Body Fat Distribution and Kidney Function after Living Kidney Donation. Clin J Am Soc Nephrol 2024; 19:503-513. [PMID: 38190119 PMCID: PMC11020429 DOI: 10.2215/cjn.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
BACKGROUND In most screening guidelines, high body mass index (BMI) is considered a contraindication for kidney donation. New insights suggest that central body fat distribution might provide greater power in assessing kidney risk. This study aimed to determine whether BMI and central body fat distribution measures are associated with long-term kidney function after donor nephrectomy. We hypothesized that higher BMI, waist circumference (WC), and waist-to-height ratio (WHtR) were associated with lower kidney function long term after donation. METHODS The study population consisted of living kidney donors. BMI, WC, and WHtR were measured during donor screening. The outcome postdonation kidney function was assessed using measured GFR (mGFR) (mGFR, 125 I-iothalamate infusion) at 3 months ( n =1042), 5 years ( n =556), and 10 years ( n =210) of follow-up. Primary multivariable linear regression analyses were performed with BMI and WC and secondary analyses with WHtR. Linear mixed models were performed to investigate change in postdonation eGFR. RESULTS The donor age was 52±11 years, and 48% were male. The mean BMI was 26.1±3.6 kg/m 2 , and WC was 91±11 cm. Higher predonation BMI was associated with lower mGFR throughout follow-up: -1.35 (95% confidence interval [CI], -1.95 to -0.80), -1.55 (95% CI, -2.50 to -0.65), and -2.35 (95% CI, -4.10 to -0.60) ml/min per m 2 per 5 kg/m 2 higher BMI at 3 months, 5, and 10 years after donation, respectively, adjusted for sex, age, and predonation GFR. For WC, differences in mGFR were -1.30 (95% CI, -1.70 to -0.90), -1.50 (95% CI, -2.20 to -0.80), and -1.70 (95% CI, -3.00 to -0.50) ml/min per m 2 per 10 cm higher WC at 3 months, 5, and 10 years after donation, respectively. In male donors, BMI and WC were significantly associated with a negative postdonation change in eGFR. CONCLUSIONS Higher BMI and WC were independently associated with lower GFR (long term) after living kidney donation.
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Affiliation(s)
- Lisa B. Westenberg
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A. Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jessica van der Weijden
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H. de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Lu F, Fan J, Li F, Liu L, Chen Z, Tian Z, Zuo L, Yu D. Abdominal adipose tissue and type 2 diabetic kidney disease: adipose radiology assessment, impact, and mechanisms. Abdom Radiol (NY) 2024; 49:560-574. [PMID: 37847262 DOI: 10.1007/s00261-023-04062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
Diabetic kidney disease (DKD) is a significant healthcare burden worldwide that substantially increases the risk of kidney failure and cardiovascular events. To reduce the prevalence of DKD, extensive research is being conducted to determine the risk factors and consequently implement early interventions. Patients with type 2 diabetes mellitus (T2DM) are more likely to be obese. Abdominal adiposity is associated with a greater risk of kidney damage than general obesity. Abdominal adipose tissue can be divided into different fat depots according to the location and function, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PAT), and renal sinus adipose tissue (RSAT), which can be accurately measured by radiology techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). Abdominal fat depots may affect the development of DKD through different mechanisms, and radiologic abdominal adipose characteristics may serve as imaging indicators of DKD risk. This review will first describe the CT/MRI-based assessment of abdominal adipose depots and subsequently describe the current studies on abdominal adipose tissue and DKD development, as well as the underlying mechanisms in patients of T2DM with DKD.
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Affiliation(s)
- Fei Lu
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Jinlei Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Fangxuan Li
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Lijing Liu
- Department of Imaging, Yantaishan Hospital, Yantai, 264001, Shandong, China
| | - Zhiyu Chen
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Ziyu Tian
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Liping Zuo
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Dexin Yu
- School of Medical Imaging, Weifang Medical University, Weifang, 261053, Shandong, China.
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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Mallamaci F, Tripepi G. Risk Factors of Chronic Kidney Disease Progression: Between Old and New Concepts. J Clin Med 2024; 13:678. [PMID: 38337372 PMCID: PMC10856768 DOI: 10.3390/jcm13030678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time and it is a worldwide health issue. The estimated frequency of CKD is 10% of the world's population, but it varies greatly on a global scale. In absolute terms, the staggering number of subjects affected by various degrees of CKD is 850,000,000, and 85% of them are in low- to middle-income countries. The most important risk factors for chronic kidney disease are age, arterial hypertension, diabetes, obesity, proteinuria, dyslipidemia, and environmental risk factors such as dietary salt intake and a more recently investigated agent: pollution. In this narrative review, we will focus by choice just on some risk factors such as age, which is the most important non-modifiable risk factor, and among modifiable risk factors, we will focus on hypertension, salt intake, obesity, and sympathetic overactivity.
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Affiliation(s)
- Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano, Bianchi-Melacrino-Morelli (BMM), 89124 Reggio Calabria, Italy
- Research Unit of Clinical Epidemiology of Reggio Calabria, Institute of Clinical Physiology (IFC), National Research Council (CNR), 89124 Reggio Calabria, Italy
| | - Giovanni Tripepi
- Research Unit of Clinical Epidemiology of Reggio Calabria, Institute of Clinical Physiology (IFC), National Research Council (CNR), 89124 Reggio Calabria, Italy
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5
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Alhummiany B, Sharma K, Buckley DL, Soe KK, Sourbron SP. Physiological confounders of renal blood flow measurement. MAGMA (NEW YORK, N.Y.) 2023:10.1007/s10334-023-01126-7. [PMID: 37971557 DOI: 10.1007/s10334-023-01126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/26/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI. METHODS A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans. RESULTS A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement. CONCLUSION Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results.
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Affiliation(s)
- Bashair Alhummiany
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, LS2 9NL, UK.
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David L Buckley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Kywe Kywe Soe
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Steven P Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
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Kitazawa A, Fukuda Y. Sex-specific association of body mass index and fatty liver index with prevalence of renal hyperfiltration: a cross sectional study using Japanese health check-up data. BMC Nephrol 2023; 24:85. [PMID: 37013497 PMCID: PMC10071694 DOI: 10.1186/s12882-023-03137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The relationship between obesity and nonalcoholic fatty liver disease and renal hyperfiltration is controversial. This study aimed to assess the correlations of body mass index and fatty liver index, respectively, with renal hyperfiltration in non-diabetic subjects, considering age, sex, and body surface area. METHODS This cross-sectional study assessed the Japanese health check-up data (FY2018) of 62,379 non-diabetic individuals from a health insurance database. Renal hyperfiltration is the ≥ 95th percentile of estimated glomerular filtration rate (derived by Chronic Kidney Disease Epidemiology Collaboration formula) by gender and age in healthy subjects. After adjusting for potential confounders, multiple logistic regression models were applied to evaluate the correlation of renal hyperfiltration with body mass index categories and fatty liver index (10 equal parts). RESULTS A negative and positive correlation, respectively, were noted when the body mass index was < 21 and ≥ 30 in women; however, a positive correlation was noted for BMI < 18.5 and ≥ 30 in men. Renal hyperfiltration prevalence increased when fatty liver index increased for both sexes; the cutoff value for fatty liver index was 14.7 for women and 30.4 for men. CONCLUSIONS Body mass index and renal hyperfiltration correlated linearly in women; however, in men, the correlation was U-shaped; therefore, differing by sex. However, fatty liver index correlated linearly with renal hyperfiltration in both sexes. Non-alcoholic fatty liver disease might be associated with renal hyperfiltration; Fatty liver index is a simple marker that can be obtained from health check-ups. Since a high fatty liver index correlated with renal hyperfiltration, it may be beneficial to monitor the renal function in such a population.
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Affiliation(s)
- Atsushi Kitazawa
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan.
- Department of Nephrology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Yoshiharu Fukuda
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan
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7
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Lee J, Min S, Oh SW, Oh S, Lee YH, Kwon H, Lee CM, Choi HC, Heo NJ. Association of intraabdominal fat with the risk of incident chronic kidney disease according to body mass index among Korean adults. PLoS One 2023; 18:e0280766. [PMID: 36757992 PMCID: PMC9910748 DOI: 10.1371/journal.pone.0280766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/08/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The association between abdominal visceral adipose tissue and the risk of incident chronic kidney disease according to body mass index in the Asian population, remains unclear. We evaluated the impact of abdominal adiposity stratified by body mass index on the risk of incident chronic kidney disease. METHODS A cohort study included 11,050 adult participants who underwent health check-ups and re-evaluated the follow-up medical examination at a single university-affiliated healthcare center. Cross-sectional abdominal adipose tissue areas were measured using computed tomography. The primary outcome was progression to chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73m2). The highest quartile of visceral adipose tissue was used for the cut-off of central obesity. RESULTS During the mean of 5.6 follow-up years, 104 incident chronic kidney disease cases were identified. The risk for chronic kidney disease incidence was significantly increased in the 3rd and 4th quartile ranges of visceral adipose tissue [hazard ratio (95% confidence interval)]: 4.59 (1.48-14.30) and 7.50 (2.33-24.20), respectively. In the analysis stratified by body mass index, the chronic kidney disease incidence risk was increased in the highest quartile range of visceral adipose tissue in the normal weight group: 7.06 (1.35-37.04). However, there was no significant relationship between visceral adipose tissue and chronic kidney disease in the obese group. Compared to the subjects with normal weight and absent central obesity, the hazard ratio for chronic kidney disease incidence was 2.32 (1.26-4.27) among subjects with normal weight and central obesity and 1.81 (1.03-3.15) among subjects with obesity and central obesity. CONCLUSION Visceral adipose tissue was a significant risk factor for subsequent chronic kidney disease progression, and the association was identified only in the normal weight group. Normal-weight central obesity was associated with excess risk of chronic kidney disease, similar to the risk in the group with obesity and central obesity.
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Affiliation(s)
- Jeonghwan Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University Hospital, Seoul, South Korea
| | - Seran Min
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
- * E-mail: (NJH); (SWO)
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Yoon-Hye Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
| | - Ho-Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
| | - Nam Ju Heo
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
- * E-mail: (NJH); (SWO)
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Kouda K, Fujita Y, Nakama C, Ohara K, Tachiki T, Tamaki J, Yura A, Moon JS, Kajita E, Imai N, Uenishi K, Iki M. Association between trunk-to-peripheral fat ratio and renal function in elderly Japanese men: baseline data from the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study. Environ Health Prev Med 2023; 28:30. [PMID: 37183008 DOI: 10.1265/ehpm.22-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Central obesity as measured by waist-to-hip circumference ratio (WHR) has been reported to be associated with renal hemodynamics and function. However, the adipose component of WHR, which is a composite measure of fat mass and fat-free mass, is small, particularly in nonobese subjects. Trunk-to-peripheral fat ratio as measured using dual-energy absorptiometry (DXA) is a more precise method for evaluating central fat distribution than WHR. The present study investigated the cross-sectional association between DXA-measured trunk-to-peripheral fat ratio and estimated glomerular filtration rate (eGFR) in community-dwelling elderly Japanese men. METHODS Participants were 575 men aged ≥65 years at the time of the baseline survey of the second Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study. Trunk-to-appendicular fat ratio (TAR) was calculated as trunk fat divided by appendicular fat (sum of arm and leg fat), and trunk-to-leg fat ratio (TLR) as trunk fat divided by leg fat. RESULTS eGFR values significantly decreased from the lowest to the highest quintile of TAR/TLR. After adjusting for potential confounding factors including whole-body fat, the highest quintile of both TAR and TLR showed statistically significant odds ratios for the risk of eGFR <60 ml/min/1.73 m2, relative to the lowest quintile. In addition, a significant decreasing trend was observed for eGFR values from the lowest to the highest quintile of TAR/TLR after adjusting for confounding factors including whole-body fat. CONCLUSION Elderly men with a large trunk-to-peripheral fat ratio tended to have a lower eGFR. This association occurred independently of that between whole-body fat and eGFR.
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Affiliation(s)
- Katsuyasu Kouda
- Department of Hygiene and Public Health, Kansai Medical University
| | - Yuki Fujita
- Center for Medical Education, Kindai University Faculty of Medicine
| | - Chikako Nakama
- Department of Hygiene and Public Health, Kansai Medical University
| | - Kumiko Ohara
- Department of Hygiene and Public Health, Kansai Medical University
| | | | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical and Pharmaceutical University
| | - Akiko Yura
- Department of Public Health, Kindai University Faculty of Medicine
| | | | | | - Nami Imai
- Department of Pharmaceutical and Medical Business Sciences, Nihon Pharmaceutical University
| | - Kazuhiro Uenishi
- Laboratory of Physiological Nutrition, Kagawa Nutrition University
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine
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Zeng W, Beyene HB, Kuokkanen M, Miao G, Magliano DJ, Umans JG, Franceschini N, Cole SA, Michailidis G, Lee ET, Howard BV, Fiehn O, Curran JE, Blangero J, Meikle PJ, Zhao J. Lipidomic profiling in the Strong Heart Study identified American Indians at risk of chronic kidney disease. Kidney Int 2022; 102:1154-1166. [PMID: 35853479 PMCID: PMC10753995 DOI: 10.1016/j.kint.2022.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022]
Abstract
Dyslipidemia associates with and usually precedes the onset of chronic kidney disease (CKD), but a comprehensive assessment of molecular lipid species associated with risk of CKD is lacking. Here, we sought to identify fasting plasma lipids associated with risk of CKD among American Indians in the Strong Heart Family Study, a large-scale community-dwelling of individuals, followed by replication in Mexican Americans from the San Antonio Family Heart Study and Caucasians from the Australian Diabetes, Obesity and Lifestyle Study. We also performed repeated measurement analysis to examine the temporal relationship between the change in the lipidome and change in kidney function between baseline and follow-up of about five years apart. Network analysis was conducted to identify differential lipid classes associated with risk of CKD. In the discovery cohort, we found that higher baseline level of multiple lipid species, including glycerophospholipids, glycerolipids and sphingolipids, was significantly associated with increased risk of CKD, independent of age, sex, body mass index, diabetes and hypertension. Many lipid species were replicated in at least one external cohort at the individual lipid species and/or the class level. Longitudinal change in the plasma lipidome was significantly associated with change in the estimated glomerular filtration rate after adjusting for covariates, baseline lipids and the baseline rate. Network analysis identified distinct lipidomic signatures differentiating high from low-risk groups. Thus, our results demonstrated that disturbed lipid metabolism precedes the onset of CKD. These findings shed light on the mechanisms linking dyslipidemia to CKD and provide potential novel biomarkers for identifying individuals with early impaired kidney function at preclinical stages.
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Affiliation(s)
- Wenjie Zeng
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Habtamu B Beyene
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mikko Kuokkanen
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
| | - Guanhong Miao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, Maryland, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - George Michailidis
- Department of Statistics, University of Florida, Gainesville, Florida, USA
| | - Elisa T Lee
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, Maryland, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California-Davis, Davis, California, USA
| | - Joanne E Curran
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.
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Martínez-Montoro JI, Morales E, Cornejo-Pareja I, Tinahones FJ, Fernández-García JC. Obesity-related glomerulopathy: Current approaches and future perspectives. Obes Rev 2022; 23:e13450. [PMID: 35362662 PMCID: PMC9286698 DOI: 10.1111/obr.13450] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
Obesity-related glomerulopathy (ORG) is a silent comorbidity which is increasing in incidence as the obesity epidemic escalates. ORG is associated with serious health consequences including chronic kidney disease, end-stage renal disease (ESRD), and increased mortality. Although the pathogenic mechanisms involved in the development of ORG are not fully understood, glomerular hemodynamic changes, renin-angiotensin-aldosterone system (RAAS) overactivation, insulin-resistance, inflammation and ectopic lipid accumulation seem to play a major role. Despite albuminuria being commonly used for the non-invasive evaluation of ORG, promising biomarkers of early kidney injury that are emerging, as well as new approaches with proteomics and metabolomics, might permit an earlier diagnosis of this disease. In addition, the assessment of ectopic kidney fat by renal imaging could be a useful tool to detect and evaluate the progression of ORG. Weight loss interventions appear to be effective in ORG, although large-scale trials are needed. RAAS blockade has a renoprotective effect in patients with ORG, but even so, a significant proportion of patients with ORG will eventually progress to ESRD despite therapeutic efforts. It is noteworthy that certain antidiabetic agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be useful in the treatment of ORG through different pleiotropic effects. In this article, we review current approaches and future perspectives in the care and treatment of ORG.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Enrique Morales
- Department of Nephrology, 12 de Octubre University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Faculty of Medicine, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - José Carlos Fernández-García
- Faculty of Medicine, University of Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y la Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Regional University Hospital of Málaga, Málaga, Spain
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11
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Zheng Y, Zhang J, Ren Z, Meng W, Tang J, Zhao S, Chi C, Xiong J, Teliewubai J, Maimaitiaili R, Xu Y, Zhang Y. Prognostic Value of Arm Circumference for Cardiac Damage and Major Adverse Cardiovascular Events: A Friend or a Foe? A 2-Year Follow-Up in the Northern Shanghai Study. Front Cardiovasc Med 2022; 9:816011. [PMID: 35811737 PMCID: PMC9260245 DOI: 10.3389/fcvm.2022.816011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe high prevalence of cardiovascular diseases globally causes a great social burden and much individual suffering. The effective recognition of high-risk subjects is critical for primary prevention in the general population. In the elderly cohort, anthropometric measurements may have different prognostic values. Our study aimed to find convincing anthropometric measures to supplement conventional risk factors for major adverse cardiovascular events (MACEs) in the elderly cohort.Materials and MethodsA total of 1,576 elderly participants (44.5% male, aged 72.0 ± 6.0 years) recruited into the Northern Shanghai Study (2014–2015) were followed up between 2016 and 2017. Following the standard guideline for cardiovascular risk evaluation, all conventional cardiovascular risk factors were assessed. The body measures were made up of body weight, body height, hip circumference, waist circumference, and middle-upper arm circumference (MUAC). Organ damage (OD) markers for cardiac, vascular, and renal diseases will be evaluated by the standardized methods.ResultsAfter the average 571 (±135) days of follow-up, a total of 90 MACEs (5.7%) occurred, i.e., 13 non-fatal myocardial infarction, 68 non-fatal stroke, and 9 cardiovascular deaths. Univariable COX survival analysis revealed that only MUAC could validly predict MACEs among anthropometric characters [adjusted hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82–0.96]. In Kaplan-Meier analysis, the group of high MUAC showed the lowest MACE risk (log-rank p = 0.01). Based on OD analysis, MUAC was independently linked to higher risk of left ventricular hypertrophy (LVH) in women and left ventricular diastolic dysfunction (LVDD) in both men and women. In adjusted COX analysis, only MUAC indicated statistical significance, but all other anthropometric parameters such as BMI, waist circumference, and waist-to-hip ratio (WHR) did not indicate significance. The higher level of MUAC remained a protective factor in fully adjusted models (HR: 0.73; 95% CI: 0.59–0.91), with p-values markedly significant in men (HR: 0.69; 95% CI: 0.49–0.97) and marginally significant in women (HR: 0.0.77; 95% CI: 0.59–1.01). After considering all factors (i.e., cardiovascular risk factors, MUAC, BMI, and WHR), the fully adjusted COX regression analysis demonstrated that the increased MUAC level was linked to decreased MACE risk in both men (HR: 0.57; 95% CI: 0.37–0.88) and women (aHR: 0.64; 95% CI: 0.46–0.93).ConclusionDespite being associated with a higher rate of cardiac damage, higher MUAC independently and significantly conferred protection against the MACE, in the elderly cohort.
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12
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Berton M, Bettonte S, Stader F, Battegay M, Marzolini C. Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models. Clin Pharmacokinet 2022; 61:1251-1270. [PMID: 35699913 PMCID: PMC9439993 DOI: 10.1007/s40262-022-01132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
Background Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation. Objective The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework. Methods A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m2 on system parameters. Results In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m2, leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%). Conclusion The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m2 using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.
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Affiliation(s)
- Mattia Berton
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sara Bettonte
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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13
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Magnitude of Drug–Drug Interactions in Special Populations. Pharmaceutics 2022; 14:pharmaceutics14040789. [PMID: 35456623 PMCID: PMC9027396 DOI: 10.3390/pharmaceutics14040789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/05/2023] Open
Abstract
Drug–drug interactions (DDIs) are one of the most frequent causes of adverse drug reactions or loss of treatment efficacy. The risk of DDIs increases with polypharmacy and is therefore of particular concern in individuals likely to present comorbidities (i.e., elderly or obese individuals). These special populations, and the population of pregnant women, are characterized by physiological changes that can impact drug pharmacokinetics and consequently the magnitude of DDIs. This review compiles existing DDI studies in elderly, obese, and pregnant populations that include a control group without the condition of interest. The impact of physiological changes on the magnitude of DDIs was then analyzed by comparing the exposure of a medication in presence and absence of an interacting drug for the special population relative to the control population. Aging does not alter the magnitude of DDIs as the related physiological changes impact the victim and perpetrator drugs to a similar extent, regardless of their elimination pathway. Conversely, the magnitude of DDIs can be changed in obese individuals or pregnant women, as these conditions impact drugs to different extents depending on their metabolic pathway.
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14
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Nunes SH, Nogueira Saad MA, da Cruz Filho RA, Jorge AJL, Santos MMSD, Martins WDA, Campos TLD, Rosa MLG. Is lipid accumulation product a better cardiovascular risk predictor in elderly individuals than anthropometric measures? Rev Port Cardiol 2021; 40:539-544. [PMID: 34392894 DOI: 10.1016/j.repce.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/11/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Population aging is associated with increased prevalence of cardiovascular diseases that have a significant impact on overall morbidity and mortality. Insulin resistance (IR) and visceral obesity are risk factors for vascular damage and cardiometabolic diseases. AIMS Estimating the correlation between lipid accumulation product (LAP) and IR in elderly individuals and comparing them to traditional anthropometric indices. METHODS Cross-sectional study comprising 411 individuals >60 years, who were treated in a primary care service. Body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), arm circumference (AC), sagittal abdominal diameter (SAD) and waist-hip ratio (WHR) were recorded. IR was estimated based on HOMA-IR (homeostasis model assessment IR index). LAPa index was calculated as [WC-65]×[triglyceride (TG)] in men, and as [WC-58]×[TG] in women, whereas LAPb was calculated by using the minimum WC values recorded for the current sample, i.e., 61.5 cm for women and 71.5 cm for men. RESULTS There was correlation among LAPa (0.506), LAPb (0.515) and HOMA-IR. LAP was better correlated to HOMA-IR and showed higher area under the curve than BMI, NC, WHR and SAD. Based on the receiver operating characteristic curve analysis, LAPb≥47.40 and LAPa≥52.5 were the best cut-off values used to identify individuals with IR presenting 68.8% and 68.2% sensitivity, and 68.6% and 68.6% specificity, respectively. CONCLUSION LAP may be a useful and simple clinical marker to assess cardiometabolic risk factors in the elderly population treated at a primary care service.
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Affiliation(s)
- Samon Henrique Nunes
- Department of Epidemiology and Statistics, Public Health Institute, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | - Rubens Antunes da Cruz Filho
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Antonio José Lagoeiro Jorge
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil.
| | - Márcia Maria Sales Dos Santos
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Wolney de Andrade Martins
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Thais Landi de Campos
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Luiza Garcia Rosa
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
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15
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Nunes SH, Nogueira Saad MA, da Cruz Filho RA, Jorge AJL, Santos MMSD, Martins WDA, Campos TLD, Rosa MLG. Is lipid accumulation product a better cardiovascular risk predictor in elderly individuals than anthropometric measures? Rev Port Cardiol 2021. [PMID: 34303578 DOI: 10.1016/j.repc.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Population aging is associated with increased prevalence of cardiovascular diseases that have a significant impact on overall morbidity and mortality. Insulin resistance (IR) and visceral obesity are risk factors for vascular damage and cardiometabolic diseases. AIMS Estimating the correlation between lipid accumulation product (LAP) and IR in elderly individuals and comparing them to traditional anthropometric indices. METHODS Cross-sectional study comprising 411 individuals >60 years, who were treated in a primary care service. Body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), arm circumference (AC), sagittal abdominal diameter (SAD) and waist-hip ratio (WHR) were recorded. IR was estimated based on HOMA-IR (homeostasis model assessment IR index). LAPa index was calculated as [WC-65]×[triglyceride (TG)] in men, and as [WC-58]×[TG] in women, whereas LAPb was calculated by using the minimum WC values recorded for the current sample, i.e., 61.5 cm for women and 71.5 cm for men. RESULTS There was correlation among LAPa (0.506), LAPb (0.515) and HOMA-IR. LAP was better correlated to HOMA-IR and showed higher area under the curve than BMI, NC, WHR and SAD. Based on the receiver operating characteristic curve analysis, LAPb≥47.40 and LAPa≥52.5 were the best cut-off values used to identify individuals with IR presenting 68.8% and 68.2% sensitivity, and 68.6% and 68.6% specificity, respectively. CONCLUSION LAP may be a useful and simple clinical marker to assess cardiometabolic risk factors in the elderly population treated at a primary care service.
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Affiliation(s)
- Samon Henrique Nunes
- Department of Epidemiology and Statistics, Public Health Institute, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | - Rubens Antunes da Cruz Filho
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Antonio José Lagoeiro Jorge
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil.
| | - Márcia Maria Sales Dos Santos
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Wolney de Andrade Martins
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Thais Landi de Campos
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Luiza Garcia Rosa
- Clinical Medicine Department, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
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16
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Chen R, Sun G, Liu R, Sun A, Cao Y, Zhou X, Zhang S. Hypertriglyceridemic waist phenotype and risk of chronic kidney disease in community-dwelling adults aged 60 years and older in Tianjin, China: a 7-year cohort study. BMC Nephrol 2021; 22:182. [PMID: 34011292 PMCID: PMC8132422 DOI: 10.1186/s12882-021-02339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The hypertriglyceridemic waist (HTGW) phenotype has been proposed to be related to the occurrence and progression of chronic kidney disease (CKD). The ageing trend of the Chinese population continues to intensify, and elderly individuals are at high risk of CKD. The purpose of this study was to investigate the cross-sectional and longitudinal associations between the HTGW phenotype and the risk of CKD by following community-dwelling adults aged 60 years and older in Tianjin, China, for 7 years. Methods This study was an observational cohort study conducted between 2013 and 2019. Of 2050 participants aged 60 years and older who underwent an annual health examination in 2013, 1605 individuals with complete data were enrolled in the cross-sectional analysis. Among them, 1271 individuals were observed until 2019. Detailed follow-up records were available for 816 participants, of whom 600 participants without CKD at baseline were eligible for inclusion in the retrospective analysis. The HTGW phenotype was defined as a waist circumference of 90 cm or more and triglyceride concentrations of 2.0 mmol/L or more in males or a waist circumference of 85 cm or more and triglyceride concentrations of 1.5 mmol/L or more in females. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 and/or proteinuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g). Multivariable logistic regression analyses were performed to evaluate the relationship between the HTGW phenotype and CKD. Results In 2013, the prevalence of CKD among older adults was 31.03%, and the prevalence of CKD in the HTGW phenotype group was 37.81%. Over a 7-year observation period, 195 individuals developed CKD, with an incidence rate of 32.50%. Statistically significant associations were observed between the HTGW phenotype and CKD in older adults in both cross-sectional surveys and retrospective analyses, with odds ratios and 95% confidence intervals of 1.38 (95% CI: 1.03–1.86, P = 0.033) and 2.27 (95% CI: 1.30–3.97, P = 0.004), respectively, after adjustment for confounders. Conclusions In this community-based cohort study, the HTGW phenotype was confirmed to be independently associated with an increased risk of prevalent and incident CKD in older adults aged 60 years and above in Tianjin, China. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02339-5.
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Affiliation(s)
- Ruping Chen
- Graduate School of Tianjin Medical University, Tianjin, 300070, China.,Department of Clinical Laboratory, Tianjin Union Medical Centre, Tianjin, 300121, China
| | - Guangshan Sun
- Tianjin Junliangcheng Hospital, Tianjin, 300301, China
| | - Rui Liu
- Department of Clinical Laboratory, Tianjin Union Medical Centre, Tianjin, 300121, China.
| | - Ao Sun
- Tianjin Junliangcheng Hospital, Tianjin, 300301, China
| | - Yujie Cao
- Graduate School of Tianjin Medical University, Tianjin, 300070, China
| | - Xiaojie Zhou
- Graduate School of Tianjin Medical University, Tianjin, 300070, China
| | - Sha Zhang
- Graduate School of Tianjin Medical University, Tianjin, 300070, China
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17
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Comparison of eGFR formulas in determining chronic kidney disease stage in bariatric patients and the impact on perioperative outcomes. Surg Obes Relat Dis 2021; 17:1317-1326. [PMID: 33879423 DOI: 10.1016/j.soard.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) independently increases the risk of 30-day adverse outcomes following metabolic and bariatric surgery (MBS). However, no studies have evaluated the stage of CKD at which increased perioperative risk is manifested. Here, we correlate 30-day major morbidities after MBS with extent of renal disease based on CKD Stage. OBJECTIVES To determine the impact of CKD stage on perioperative outcomes after bariatric surgery. SETTING Academic Hospital. METHODS From the 2017 Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database, we identified patients with CKD who underwent sleeve gastrectomy or laparoscopic gastric bypass surgery. Glomerular filtration rates (GFRs) were calculated and cohorts were generated based on CKD Stage. Complication rates and rates of morbidity and mortality were compared between stages, and strengths of correlation were calculated. RESULTS GFR and CKD Stage were calculated for 150,283 patients. There was a significant increase in the risk of major morbidity at each progressive stage of CKD (P < .001 for all compared stages). There was a strong positive linear correlation between increasing CKD Stage and total morbidity (r2 = .983), including reoperation ( r2 = .784), readmission (r2 = .936), unplanned ICU transfer (r2 = .853), and aggregate complications such as pulmonary (r2 = .900), bleeding (r2 = .878), or progressive worsening of renal function (r2 = .845). In logistic regression, for every 10-point decrease in GFR, odds of total morbidity increased by 6%. CONCLUSION An increased risk of perioperative complications may be seen in early stages of CKD, and risk is compounded in more advanced stages. Bariatric surgical candidates should be counseled on their increased risk of surgical complications even with mild CKD, and the benefits of bariatric surgery should be carefully weighed against significantly increased risks of complications in severe CKD.
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18
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Qiu Y, Zhao Q, Wang N, Yu Y, Wang R, Zhang Y, Cui S, Zhu M, Liu X, Jiang Y, Zhao G. Association of hypertriglyceridemic waist phenotype with renal function impairment: a cross-sectional study in a population of Chinese adults. Nutr Metab (Lond) 2020; 17:63. [PMID: 32774441 PMCID: PMC7409629 DOI: 10.1186/s12986-020-00483-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hypertriglyceridemic waist (HTGW) phenotype has been suggested as a risk factor for chronic kidney disease (CKD). However, there is limited evidence on the relationship of triglyceride waist phenotypes with estimated glomerular filtration rate (eGFR) status and severity. Our aim was to explore the associations of triglyceride waist phenotypes with reduced eGFR and various decreased eGFR stages among Chinese adults. Methods A population-based, cross-sectional study was conducted among Chinese participants aged 20–74 years from June 2016 to December 2017 in Shanghai, China. An eGFR value below 60 mL/min/1.73 m2 was defined as decreased eGFR. HTGW phenotype was defined as triglyceride (TG) ≥1.7 mmol/L and a waist circumference (WC) of ≥90 cm for men and ≥ 80 cm for women. We examined the association of triglyceride waist phenotypes with decreased eGFR risk using the weighted logistic regression models. Results A total of 31,296 adults were included in this study. Compared with normal TG level/normal WC (NTNW) phenotype, normal TG level/enlarged WC (NTGW) and elevated TG level/enlarged WC (HTGW) phenotypes were associated with the increased risk of decreased eGFR. Multivariable-adjusted ORs (95% CI) associated with NTGW, elevated TG level/normal WC (HTNW), and HTGW phenotypes were 1.75 (1.41–2.18), 1.29 (0.99–1.68), and 1.99 (1.54–2.58), respectively. These associations between triglyceride waist phenotypes and decreased eGFR risk remained across almost all the subgroups, including sex, age, BMI, T2DM, and hypertension. HTGW phenotype was consistently positively associated with the risk of mildly and moderately decreased eGFR, but not with severely decreased eGFR risk. Conclusions HTGW was consistently associated with the increased risk of decreased eGFR and various decreased eGFR stages, except for severely decreased eGFR. Further prospective studies are warranted to confirm our findings and to investigate the underlying biological mechanisms.
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Affiliation(s)
- Yun Qiu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Na Wang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Yuting Yu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Ruiping Wang
- Songjiang District Center for Disease Control and Prevention, Shanghai, 201600 China
| | - Yue Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Shuheng Cui
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Meiying Zhu
- Songjiang District Center for Disease Control and Prevention, Shanghai, 201600 China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
| | - Yonggen Jiang
- Songjiang District Center for Disease Control and Prevention, Shanghai, 201600 China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032 China
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19
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McPherson KC, Shields CA, Poudel B, Johnson AC, Taylor L, Stubbs C, Nichols A, Cornelius DC, Garrett MR, Williams JM. Altered renal hemodynamics is associated with glomerular lipid accumulation in obese Dahl salt-sensitive leptin receptor mutant rats. Am J Physiol Renal Physiol 2020; 318:F911-F921. [PMID: 32068459 DOI: 10.1152/ajprenal.00438.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The present study examined whether development of renal injury in the nondiabetic obese Dahl salt-sensitive leptin receptor mutant (SSLepRmutant) strain is associated with elevations in glomerular filtration rate and renal lipid accumulation. Baseline mean arterial pressure at 6 wk of age was similar between Dahl salt-sensitive wild-type (SSWT) and SSLepRmutant rats. However, by 18 wk of age, the SSLepRmutant strain developed hypertension, while the elevation in mean arterial pressure was not as severe in SSWT rats (192 ± 4 and 149 ± 6 mmHg, respectively). At baseline, proteinuria was fourfold higher in SSLepRmutant than SSWT rats and remained elevated throughout the study. The early development of progressive proteinuria was associated with renal hyperfiltration followed by a decline in renal function over the course of study in the SSLepRmutant compared with SSWT rats. Kidneys from the SSLepRmutant strain displayed more glomerulosclerosis and glomerular lipid accumulation than SSWT rats. Glomeruli were isolated from the renal cortex of both strains at 6 and 18 wk of age, and RNA sequencing was performed to identify genes and pathways driving glomerular injury. We observed significant increases in expression of the influx lipid transporters, chemokine (C-X-C motif) ligand 16 (Cxcl16) and scavenger receptor and fatty acid translocase (Cd36), respectively, and a significant decrease in expression of the efflux lipid transporter, ATP-binding cassette subfamily A member 2 (Abca2; cholesterol efflux regulatory protein 2), in SSLepRmutant compared with SSWT rats at 6 and 18 wk of age, which were validated by RT-PCR analysis. These data suggest an association between glomerular hyperfiltration and glomerular lipid accumulation during the early development of proteinuria associated with obesity.
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Affiliation(s)
- Kasi C McPherson
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Corbin A Shields
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Bibek Poudel
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ashley C Johnson
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lateia Taylor
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cassandra Stubbs
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Alyssa Nichols
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Denise C Cornelius
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jan M Williams
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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Comini LDO, de Oliveira LC, Borges LD, Dias HH, Batistelli CRS, da Silva LS, Moreira TR, da Silva RG, Cotta RMM. Individual and Combined Components of Metabolic Syndrome with Chronic Kidney Disease in Individuals with Hypertension and/or Diabetes Mellitus Accompanied by Primary Health Care. Diabetes Metab Syndr Obes 2020; 13:71-80. [PMID: 32021353 PMCID: PMC6956993 DOI: 10.2147/dmso.s223929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/07/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To identify the associations between MetS and its components and chronic kidney disease (CKD) in a population with arterial hypertension (AH), or diabetes mellitus (DM) accompanied by the Primary Health Care (PHC). PATIENTS AND METHODS A cross-sectional study with 788 individuals diagnosed with AH and/or DM followed by PHC of Viçosa, Brazil. Anthropometric, biochemical and clinical measures were performed for the diagnosis of MetS and CKD. MetS was identified using the NCEP-ATPIII criteria. CKD was identified by estimating the glomerular filtration rate using the CKD-EPI equation. Logistic regression models were used to estimate the chances of CKD associated with MetS and its components and specific combinations of components. RESULTS The prevalence of MetS reported in the population was 65.4%, that of hidden CKD was 15.4%. The prevalence of CKD among participants with MetS was 75.2%. The most prevalent component of MetS in the population was AH (96.7%). Elevated fasting blood glucose, central obesity, and reduced HDL-c were significantly associated with an increased chance of CKD (OR = 2.80, 95% CI 1.76-4.45, OR = 1.68, 95% CI, 05-2.71, OR = 1.61, CI 95% 1.03-2.50, respectively). For the multivariate adjustment, the participants with MetS were 2 times more likely to have CKD than those without MetS (OR = 2.07; 95% CI, 1.25-3.44). The combination of three components of MetS high blood pressure, abdominal obesity and elevated fasting blood glucose and the combination of four components of MetS high blood pressure, reduced HDL-c, high fasting blood glucose and abdominal obesity were associated with increased odds of CKD (OR = 2.67, CI 95% 1.70-4.20, OR = 2.50, CI 95% 1.55-4.02, respectively). CONCLUSION MetS, as well as its individual or combined components were independently associated with CKD in the population with AH and/or DM accompanied by PHC.
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Affiliation(s)
- Luma de O Comini
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
- Correspondence: Luma de O Comini Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Annex Building of the Biological Sciences Center II, University Campus, s/nº. Sala 101. Federal University of Viçosa, Viçosa, MGCEP: 36570-900, BrazilTel +55 31 3612-7538Fax +55 31 3612-5187 Email
| | - Laura C de Oliveira
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Luiza D Borges
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Heloísa H Dias
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Clara R S Batistelli
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Luciana S da Silva
- Medicine School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Tiago R Moreira
- Department of Nursing and Medicine, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | - Rodrigo G da Silva
- Clinical Director of the Hemodialysis Service, São João Batista Hospital, Viçosa, Minas Gerais, Brasil
| | - Rosângela M M Cotta
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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21
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Chen T, Wang X, Wang X, Chen H, Xiao H, Tang H, Feng L, Xiang Z, Zou H, Shao X. Comparison of Novel Metabolic Indices in Estimation of Chronic Kidney Diseases in a Southern Chinese Population. Diabetes Metab Syndr Obes 2020; 13:4919-4927. [PMID: 33328750 PMCID: PMC7735784 DOI: 10.2147/dmso.s286565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To determine the optimal cut-off values and evaluate the associations of product of triacylglycerol and glucose (TyG), lipid accumulation product (LAPI), visceral adiposity index (VAI) with chronic kidney diseases (CKD) stratified by sex. METHODS From January to April 2018, our team had conducted a large-scale cross-sectional survey that contained 2720 individuals on the southern coast of China. Logistic regression analysis and receiver operating characteristic (ROC) analyses were used to evaluate the optimal cut-off and value of TyG, LAPI, VAI for predicting CKD. RESULTS A multivariate logistic regression analysis found that the TyG had the better value of prediction for the presence of CKD for the highest quartile vs the lowest quartile in both males (OR: 3.65; 95% CI, 2.04-6.52; p<0.001) and females (OR: 3.50; 95% CI, 2.20-5.56; p<0.001), followed by LAPI and VAI, when further adjusted for cofounder factors, LAPI and VAI both lost their independence, and only TyG remains its significant association with CKD in both males (OR: 2.81; 95% CI, 1.25-6.30; p<0.001) and females (OR: 3.22; 95% CI, 1.56-6.61; p<0.001). ROC curve showed that TyG had the highest AUC for predicting CKD in males (AUC: 0.618). TyG (AUC: 0.670) and LAPI (AUC: 0.670) both had the highest AUC in females. United predicted models which contain TyG were conducted for predicting CKD in males (AUC: 758) and females (AUC: 0.773) and results indicated that multivariate analysis of TyG and other traditional factors can impressively improve the accuracy of predictive probability for CKD. CONCLUSION TyG is a priority to the other two novel indices and may become valuable makers and have strong predictive power for predicting CKD, especially in females.
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Affiliation(s)
- Tong Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xuan Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Xin Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Haishan Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hua Xiao
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hongjuan Tang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Ling Feng
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Zhicong Xiang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
| | - Hequn Zou
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
- Department of Nephrology, Pinghu Hospital, Health Science Center, Shenzhen University, Shenzhen518116, People’s Republic of China
- Hequn Zou No. 1, Fuxin Road, Pinghu Street, Longgang District, Shenzhen518116, People’s Republic of China Email
| | - Xiaofei Shao
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China
- Correspondence: Xiaofei Shao Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou510630, People’s Republic of China Email
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22
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Zhou C, Li Y, Shao X, Zou H. Identification of chronic kidney disease risk in relatively lean Southern Chinese: the hypertriglyceridemic waist phenotype vs. anthropometric indexes. Eat Weight Disord 2018; 23:885-892. [PMID: 29372543 PMCID: PMC6244600 DOI: 10.1007/s40519-017-0476-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/27/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Assessing and comparing the ability of the hypertriglyceridemic waist (HW) phenotype and anthropometric obesity indexes to identify subjects at high risk of chronic kidney disease (CKD) in a relatively lean population in South China. METHODS Using data from a community-based, cross-sectional study conducted in Zhuhai City, Southern China, we examined associations between the HW phenotype, anthropometric obesity indexes, and incident CKD risk in a relatively lean population. Multiple logistic regression analyses were used to evaluate the associations. RESULTS The HW phenotype associated with CKD significantly in the unadjusted analysis (OR 3.53, 95% CI 1.65-7.52, P = 0.001). Further adjustment for gender, age, and other potential confounding variables had an impact on the odd ratios (OR); the OR decreased but still existed (OR 2.91, 95% 1.23-6.87, P = 0.016). The association of the HW phenotype with CKD remained significant after further adjustment for hypertension and diabetes. No significant association between the anthropometric indexes and incident CKD was found. CONCLUSION The HW phenotype, but not the anthropometric indexes, is associated with an elevated risk of CKD in relatively lean subjects. The HW phenotype appears to be a better predictor of CKD than the anthropometric indexes. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Chaomin Zhou
- Department of Nephrology, The People's Hospital of Guizhou Province, Guiyang, 550002, China
| | - Yongqiang Li
- Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Xiaofei Shao
- Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Hequn Zou
- Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.
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23
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Rampanelli E, Ochodnicky P, Vissers JP, Butter LM, Claessen N, Calcagni A, Kors L, Gethings LA, Bakker SJ, de Borst MH, Navis GJ, Liebisch G, Speijer D, van den Bergh Weerman MA, Jung B, Aten J, Steenbergen E, Schmitz G, Ballabio A, Florquin S, Aerts JM, Leemans JC. Excessive dietary lipid intake provokes an acquired form of lysosomal lipid storage disease in the kidney. J Pathol 2018; 246:470-484. [PMID: 30073645 DOI: 10.1002/path.5150] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 06/15/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
Obesity and dyslipidaemia are features of the metabolic syndrome and risk factors for chronic kidney disease. The cellular mechanisms connecting metabolic syndrome with chronic kidney disease onset and progression remain largely unclear. We show that proximal tubular epithelium is a target site for lipid deposition upon overnutrition with a cholesterol-rich Western-type diet. Affected proximal tubule epithelial cells displayed giant vacuoles of lysosomal or autophagosomal origin, harbouring oxidised lipoproteins and concentric membrane layer structures (multilamellar bodies), reminiscent of lysosomal storage diseases. Additionally, lipidomic analysis revealed renal deposition of cholesterol and phospholipids, including lysosomal phospholipids. Proteomic profiles of renal multilamellar bodies were distinct from those of epidermis or lung multilamellar bodies and of cytoplasmic lipid droplets. Tubular multilamellar bodies were observed in kidney biopsies of obese hypercholesterolaemic patients, and the concentration of the phospholipidosis marker di-docosahexaenoyl (22:6)-bis(monoacylglycerol) phosphate was doubled in urine from individuals with metabolic syndrome and chronic kidney disease. The enrichment of proximal tubule epithelial cells with phospholipids and multilamellar bodies was accompanied by enhanced inflammation, fibrosis, tubular damage markers, and higher urinary electrolyte content. Concomitantly to the intralysosomal lipid storage, a renal transcriptional response was initiated to enhance lysosomal degradation and lipid synthesis. In cultured proximal tubule epithelial cells, inhibition of cholesterol efflux transport or oxysterol treatment induced effects very similar to the in vivo situation, such as multilamellar body and phospholipid amassing, and induction of damage, inflammatory, fibrotic, and lipogenic molecules. The onset of phospholipidosis in proximal tubule epithelial cells is a novel pathological trait in metabolic syndrome-related chronic kidney disease, and emphasises the importance of healthy lysosomes and nutrition for kidney well-being. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Elena Rampanelli
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Ochodnicky
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Loes M Butter
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nike Claessen
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alessia Calcagni
- Department of Translational Medicine, Telethon Institute of Genetics and Medicine (TIGEM) & Medical Genetics, Federico II University, Naples, Italy
| | - Lotte Kors
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Stephan Jl Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerhard Liebisch
- Division of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Dave Speijer
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bettina Jung
- Division of Nephrology, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Aten
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Steenbergen
- Department of Pathology, RIMLS, RIHS, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerd Schmitz
- Division of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Andrea Ballabio
- Department of Translational Medicine, Telethon Institute of Genetics and Medicine (TIGEM) & Medical Genetics, Federico II University, Naples, Italy
| | - Sandrine Florquin
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Mfg Aerts
- Department of Biochemistry, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Jaklien C Leemans
- Pathology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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24
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van Londen M, Schaeffers AWMA, de Borst MH, Joles JA, Navis G, Lely AT. Overweight young female kidney donors have low renal functional reserve postdonation. Am J Physiol Renal Physiol 2018; 315:F454-F459. [PMID: 29357424 DOI: 10.1152/ajprenal.00492.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Maintenance of adequate renal function after living kidney donation is important for donor outcome. Overweight donors, in particular, may have an increased risk for end-stage kidney disease (ESKD), and young female donors have an increased preeclampsia risk. Both of these risks may be associated with low postdonation renal functional reserve (RFR). Because we previously found that higher body mass index (BMI) was associated with lower postdonation RFR, we now studied the relationship between BMI and RFR in young female donors. RFR, the rise in glomerular filtration rate (GFR) (125I-iothalamate clearance) during dopamine, was measured in female donors (<45 yr) before and after kidney donation. Donors who are overweight (BMI >25) and nonoverweight donors were compared by Student's t-test; the association was subsequently explored with regression analysis. We included 105 female donors [age 41 (36-44) median(IQR)] with a BMI of 25 (22-27) kg/m2. Predonation GFR was 118 (17) ml/min [mean(SD)] rising to 128 (19) ml/min during dopamine; mean RFR was 10 (10) ml/min. Postdonation GFR was 76 (13) ml/min, rising to 80 (12); RFR was 4 (6) ml/min ( P < 0.001 vs. predonation). In overweight donors, RFR was fully lost after donation (1 ml/min vs. 10 ml/min predonation, P < 0.001), and BMI was inversely associated with RFR after donation, independent of confounders (standardized β 0.37, P = 0.02). Reduced RFR might associate with the risk of preeclampsia and ESKD in kidney donors. Prospective studies should explore whether RFR is related to preeclampsia and whether BMI reduction before conception is of benefit to overweight female kidney donors during and after pregnancy.
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Affiliation(s)
- Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Anouk W M A Schaeffers
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - A Titia Lely
- Department of Obstetrics and Gynecology, Division of Women and Baby, University Medical Center Utrecht , Utrecht , The Netherlands
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25
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MESH Headings
- Adipokines/metabolism
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/physiopathology
- Adiposity
- Animals
- Comorbidity
- Energy Metabolism
- Humans
- Inflammation Mediators/metabolism
- Kidney/metabolism
- Kidney/physiopathology
- Obesity/epidemiology
- Obesity/metabolism
- Obesity/physiopathology
- Obesity/therapy
- Obesity, Metabolically Benign/epidemiology
- Obesity, Metabolically Benign/metabolism
- Obesity, Metabolically Benign/physiopathology
- Obesity, Metabolically Benign/therapy
- Prognosis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/physiopathology
- Renal Insufficiency, Chronic/therapy
- Risk Factors
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Affiliation(s)
- Jay I Lakkis
- University of Hawaii John A. Burns School of Medicine, 95 Maui Lani Pkwy, Wailuku, HI 96793-2416
| | - Mathew R Weir
- Division of Nephrology, University of Maryland School of Medicine, 22 S. Greene St., Room N3W143, Baltimore, MD 21201.
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26
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27
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Favre G, Schiavo L, Lemoine S, Esnault VLM, Iannelli A. Longitudinal assessment of renal function in native kidney after bariatric surgery. Surg Obes Relat Dis 2018; 14:1411-1418. [PMID: 30077663 DOI: 10.1016/j.soard.2018.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/09/2018] [Accepted: 05/16/2018] [Indexed: 12/31/2022]
Abstract
The epidemic of obesity parallels that of chronic kidney disease (CKD). Obesity worsens the course of CKD, mainly defined by an abnormal glomerular filtration rate (GFR). Patients with severe obesity stages (II and III with body mass index >35 kg/m2) are eligible for bariatric surgery (BS), which is the most efficient method of achieving durable weight loss. BS may reverse glomerular hyperfiltration and albuminuria, improve adipocytokine profile, and relieve diabetes and hypertension. Obesity remission after BS might prevent the progression of renal failure in populations with morbid obesity. However, evidence for the beneficial effect of BS on renal function is scant. This lack of knowledge is mainly due to methodologic reasons, which are addressed in this review. The reversibility of hyperfiltration due to the presence of functional renal reserve hampers the interpretation of changes in true GFR after BS. This true GFR is only obtained with the renal clearance of an exogenous filtration marker. Estimation of GFR is generally provided by prediction equations, namely by modification of diet in renal diseases or by chronic kidney disease-epidemiology collaborative group. These equations are not accurate because the serum levels of both creatinine and cystatin C depend on extrarenal factors, which are modified by BS. Comparing the slopes of measured GFR according to various durations of exposure with morbid obesity would be critical in providing reliable data. Herein, we review the current knowledge on the effects of BS on kidney function; we specify the methodologic issues and particularities of the dietary management of CKD patients to propose reliable directions for future clinical research.
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Affiliation(s)
- Guillaume Favre
- Service de Néphrologie-Dialyses-Transplantation, Hôpital Pasteur, Nice; CNRS-UMR 7370 - Laboratoire de Physiomedecine moléculaire, Nice; Université Côte d'Azur, Faculté de Médecine, Nice.
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania Luigi Vanvitelli, Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Sandrine Lemoine
- Service de néphrologie et d'exploration fonctionnelle rénale, Lyon, France; Université de Lyon, Université Lyon 1, Villeurbanne, France; Centre de référence des maladies rénales rares, Bron, France
| | - Vincent L M Esnault
- Service de Néphrologie-Dialyses-Transplantation, Hôpital Pasteur, Nice; Université Côte d'Azur, Faculté de Médecine, Nice
| | - Antonio Iannelli
- Université Côte d'Azur, Faculté de Médecine, Nice; Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France; INSERM, U1065, Team 8 "Hepatic complications of obesity", Nice, France
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28
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Bjornstad P, Lovshin JA, Lytvyn Y, Boulet G, Lovblom LE, Alhuzaim ON, Farooqi MA, Lai V, Tse J, Cham L, Orszag A, Scarr D, Weisman A, Keenan HA, Brent MH, Paul N, Bril V, Perkins BA, Cherney DZI. Adiposity Impacts Intrarenal Hemodynamic Function in Adults With Long-standing Type 1 Diabetes With and Without Diabetic Nephropathy: Results From the Canadian Study of Longevity in Type 1 Diabetes. Diabetes Care 2018; 41:831-839. [PMID: 29437821 PMCID: PMC5860840 DOI: 10.2337/dc17-2475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (n = 66, duration ≥50 years) and age-/sex-matched control subjects (n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m2 and <30 mg/day urine albumin) and 22 patients with DN (eGFR ≤60 mL/min/1.73 m2 or ≥30 mg/day urine albumin). Intrarenal hemodynamic function (glomerular filtration rate for inulin [GFRINULIN], effective renal plasma flow for p-aminohippuric acid [ERPFPAH]) was measured. Afferent arteriolar resistance, efferent arteriolar resistance, renal blood flow, renal vascular resistance [RVR], filtration fraction, and glomerular pressure were derived from the Gomez equations. Fat and lean mass were quantified by DXA. RESULTS Whereas measures of adiposity did not associate with GFRINULIN or ERPFPAH in healthy control subjects, trunk fat mass inversely correlated with GFRINULIN (r = -0.46, P < 0.0001) and ERPFPAH (r = -0.31, P = 0.01) and positively correlated with RVR (r = 0.53, P = 0.0003) in type 1 diabetes. In analyses stratified by DN status, greater central adiposity related to lower GFRINULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPFPAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. CONCLUSIONS The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function.
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Affiliation(s)
- Petter Bjornstad
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of Endocrinology, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Julie A Lovshin
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Genevieve Boulet
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Omar N Alhuzaim
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohammed A Farooqi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vesta Lai
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josephine Tse
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Cham
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alanna Weisman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Michael H Brent
- Department of Ophthalmology and Vision Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Narinder Paul
- Division of Cardiothoracic Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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29
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Griffith JR, White ED, Fass RD, Lucas BM. Comparison of Body Composition Metrics for United States Air Force Airmen. Mil Med 2018; 183:e201-e207. [PMID: 29365181 DOI: 10.1093/milmed/usx053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background The United States Air Force currently uses AFI 36-2905 for cardiovascular fitness standards and evaluation. Regarding its fitness test, the Air Force considers waist circumference (WC) twice as important as push-ups or sit-ups. Because of this weighting, one assumes that the Air Force considers WC relatively correlated with overall fitness or at least cardiovascular fitness. To our knowledge, the Air Force has not considered on a large scale how body mass index (BMI), height-to-weight ratio (H-W), or waist-to-height ratio (WHtR) compares with WC with respect to its fitness test. Methods Using a 5.38 million record database from the Air Force Fitness Management System, we evaluated how WC, BMI, WHtR, and H-W correlate with fitness as assessed by the 1.5-mile run in addition to total fitness, which incorporates the 1.5-mile run time, number of push-ups and sit-ups. As this previously collected data were anonymous to us, this study fell under the definition of exempt status and approved by the institutional review board overseeing Joint Base San Antonio. For each waist metric, we performed a simple ordinary least squares regression to ascertain the correlation between that particular metric and either run time or total fitness; when incorporating more than one explanatory variable or covariate (to control for age and/or sex), we performed multiple ordinary least squares regressions. Due to the large database size and to mitigate against a type I error, we used an alpha of 0.001 for all statistical hypothesis tests. Findings Approximately 18% of the 5.38 million records belonged to women. With respect to sex differences, males appeared noticeably faster and performed more push-ups on average than females. The number of sit-ups completed was more comparable, with males having a slight advantage. Males also appeared to have larger WC, BMI, H-W, and WHtR measurements. We compared the ordinary least squares results between WC, H-W, WHtR, and BMI and ranked them by R2. Models varied in R2 from 1% to 46% depending on the covariates in the model, with sex having a greater effect than age. Whether individually or adjusting for age and sex, WHtR performed better than the other body composition variables with an average rank score of 1.1 and a median improvement of approximately 4% to the current Air Force metric of WC. Discussion From our findings, we present a 20-point WHtR scoring system for the Air Force to use in lieu of its traditional usage of WC. We used this assessment chart to score all Airmen in our database and compared the results to their current scores on the abdominal circumference portion of the test with respect to predicting run time, after accounting for sex, age, and number of push-ups and sit-ups. The R2 value improved from 40.3 to 43.6, a relative improvement of approximately 8%, a fairly significant effect given the database consisted of over 5 million records. Future studies should investigate the longitudinal effect of varying waist metrics over time on run time or total fitness performance.
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Affiliation(s)
- J R Griffith
- Air Force Institute of Technology, Department of Mathematics and Statistics 2950 Hobson Way, Wright-Patterson AFB, OH 45433
| | - Edward D White
- Air Force Institute of Technology, Department of Mathematics and Statistics 2950 Hobson Way, Wright-Patterson AFB, OH 45433
| | - R David Fass
- Air Force Institute of Technology, Department of Systems Engineering and Management, 2950 Hobson Way, Wright-Patterson AFB, OH 45433
| | - Brandon M Lucas
- Air Force Institute of Technology, Department of Systems Engineering and Management, 2950 Hobson Way, Wright-Patterson AFB, OH 45433
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Patel HP, Saland JM, Ng DK, Jiang S, Warady BA, Furth SL, Flynn JT. Waist Circumference and Body Mass Index in Children with Chronic Kidney Disease and Metabolic, Cardiovascular, and Renal Outcomes. J Pediatr 2017; 191:133-139. [PMID: 29173296 PMCID: PMC5728693 DOI: 10.1016/j.jpeds.2017.08.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/08/2017] [Accepted: 08/17/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To describe the prevalence of obesity as estimated by waist circumference (WC) and body mass index (BMI) and compare associations of WC and BMI with indicators of metabolic, cardiovascular, and renal health in children with chronic kidney disease (CKD). STUDY DESIGN Cross-sectional analysis stratified by CKD etiology (nonglomerular or glomerular) of 737 subjects. The kappa statistic was used to assess agreement between the 2 measures of obesity. Linear regression models were performed using WC and BMI as separate independent variables. Dependent variables included lipid measures, insulin resistance, blood pressure, left ventricular mass index, proteinuria, and estimated glomerular filtration rate. Associations were scaled to SD and interpreted as the change in dependent variable associated with a 1-SD change in WC or BMI. RESULTS There was good agreement (kappa statistic = 0.68) between WC and BMI in identifying obesity. Approximately 10% of subjects had obesity by 1 measure but not the other. BMI was more strongly associated with estimated glomerular filtration rate than WC. BMI was more strongly associated with left ventricular mass index in the nonglomerular CKD group compared with WC, but both had significant associations. The associations between WC and BMI with the remainder of the dependent variables were not significantly different. CONCLUSIONS Measurement of WC added limited information to BMI in this cohort. Further longitudinal study is needed to determine how WC and BMI compare in predicting outcomes, particularly for children with CKD identified as having obesity by 1 measure but not the other.
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Affiliation(s)
- Hiren P Patel
- Department of Pediatrics, Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH.
| | - Jeffrey M Saland
- Department of Pediatrics, Icahn School of Medicine at Mount
Sinai
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health
| | - Shuai Jiang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health
| | | | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the
University of Pennsylvania
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington and Seattle
Children’s Hospital
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Ramezankhani A, Azizi F, Ghanbarian A, Parizadeh D, Hadaegh F. The hypertriglyceridemic waist and waist-to-height ratio phenotypes and chronic kidney disease: Cross-sectional and prospective investigations. Obes Res Clin Pract 2017; 11:585-596. [DOI: 10.1016/j.orcp.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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Fotheringham J, Kawar B, McKane W, Ellam T. Obesity modulates the association between systolic blood pressure and albuminuria. Nephrol Dial Transplant 2017; 33:607-613. [DOI: 10.1093/ndt/gfx081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/01/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | | | - Timothy Ellam
- Sheffield Kidney Institute, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Royal Hallamshire Hospital, Sheffield, UK
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Favre G, Grangeon-Chapon C, Raffaelli C, François-Chalmin F, Iannelli A, Esnault V. Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass. PLoS One 2017; 12:e0175561. [PMID: 28423008 PMCID: PMC5396915 DOI: 10.1371/journal.pone.0175561] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/28/2017] [Indexed: 02/08/2023] Open
Abstract
Deposition of perirenal adipose tissue has been associated with adverse renal and cardiovascular events. We compared various methods to measure perirenal adipose tissue using computerized tomography (CT)-scan and performed correlations with anthropometric measures associated with renal and cardiovascular events. Voluntary overweight and obese subjects undergoing a CT-scan for diagnostic purposes were included in the study. Perirenal adipose tissue volume, adipose tissue area of the renal sinus and perirenal fat thickness were manually measured bilaterally. The intra- and inter-observer coefficient correlations and the correlation between the diverse measures of renal adipose tissue, subcutaneous (SC-)fat and anthropometrics measures were analyzed using Pearson's correlation tests. The forty included patients (24 men, 16 women) had a mean age of 57.6 ± 18.1 years and a mean body mass index of 28.9 ± 2.9 kg/m2. Despite comparable waist circumference, women had a greater SC-fat thickness compared to men, and therefore a smaller amount of visceral fat, as well as smaller perirenal fat volumes. Perirenal fat thickness was better correlated with perirenal fat volume than adipose area of the renal sinus (p <0.02). The adipose area of the renal sinus did not correlate with any anthropometric measures. In women, perirenal fat volume and thickness showed a negative correlation with SC-fat thickness and no correlation with waist circumference. In men, perirenal fat volume and thickness showed a positive correlation with waist circumference and no correlation with subcutaneous fat thickness. In conclusion, perirenal fat thickness measured with CT-scan at the level of the renal veins is a simple and reliable estimate of perirenal fat volume, that correlated negatively with SC-fat in women and positively with waist circumference in men. The adipose area of the renal sinus did not correlate with any anthropometric measure.
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Affiliation(s)
- Guillaume Favre
- Nephrology Unit, Nice University Hospital, Nice, France
- University of Nice Sophia-Antipolis, Nice, France
- Institute for Research on Cancer and Aging, Nice (IRCAN), “Aging and Diabetes” team, Nice, France
- * E-mail:
| | | | | | | | - Antonio Iannelli
- University of Nice Sophia-Antipolis, Nice, France
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France
- Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice, France
| | - Vincent Esnault
- Nephrology Unit, Nice University Hospital, Nice, France
- University of Nice Sophia-Antipolis, Nice, France
- Institute for Research on Cancer and Aging, Nice (IRCAN), “Aging and Diabetes” team, Nice, France
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Zeng J, Liu M, Wu L, Wang J, Yang S, Wang Y, Yao Y, Jiang B, He Y. The Association of Hypertriglyceridemic Waist Phenotype with Chronic Kidney Disease and Its Sex Difference: A Cross-Sectional Study in an Urban Chinese Elderly Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121233. [PMID: 27983610 PMCID: PMC5201374 DOI: 10.3390/ijerph13121233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/28/2022]
Abstract
Background: The primary objective of this study was to explore the association of hypertriglyceridemic waist (HTGW) phenotype with chronic kidney disease (CKD) and its sex difference in an urban Chinese elderly population. Methods: In a cross-sectional study, a total of 2102 participants aged 60–95 years were recruited and classified into four phenotypes: normal waist-normal triglyceride (NWNT), normal waist-elevated triglycerides (NWET), elevated waist-normal triglycerides (EWNT), and HTGW. Logistic regression analysis was used to estimate the associations of interest. Results: Total prevalence of CKD was 12.6%, and the CKD prevalence in participants with EWNT and HTGW was higher than with NWNT and NWET without regard to sex. Compared to NWNT phenotype, the adjusted OR for CKD was 1.95 (95% CI: 1.32–2.88) in HTGW groups. In contrast with the null findings (OR: 1.66; 95% CI: 0.94–2.94) in women after additional adjustment for diabetes and hypertension, the OR with HTGW remained strong (OR: 1.88; 95% CI: 1.04–3.39) in men. Similar findings appeared with the EWNT phenotype. Conclusions: The HTGW phenotype is positively associated with CKD among Chinese community elderly and may have a greater impact on men. More attention should be paid to the association between triglycerides and waist circumference in clinical practice and to the further identification this uncertain sex-related association.
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Affiliation(s)
- Jing Zeng
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Miao Liu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Jianhua Wang
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Shanshan Yang
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yiyan Wang
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yao Yao
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
| | - Bin Jiang
- Department of Chinese Traditional Medicine and Acupuncture, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Beijing 100853, China.
- State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing 100853, China.
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Stefansson VTN, Schei J, Jenssen TG, Melsom T, Eriksen BO. Central obesity associates with renal hyperfiltration in the non-diabetic general population: a cross-sectional study. BMC Nephrol 2016; 17:172. [PMID: 27832768 PMCID: PMC5103601 DOI: 10.1186/s12882-016-0386-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/01/2016] [Indexed: 01/22/2023] Open
Abstract
Background Obesity is a risk factor for end-stage renal disease. Renal hyperfiltration, defined as an abnormally high glomerular filtration rate (GFR), is a link in the causal chain between diabetes and chronic kidney disease. Whether obesity is associated with hyperfiltration in the non-diabetic general population, remains unresolved due to a lack of consensus regarding the definition of hyperfiltration and the limited precision of high-range GFR estimations with creatinine and/or cystatin C. Methods 1555 middle-aged participants without diabetes, renal or cardiovascular disease were enrolled from the general population in the Renal Iohexol Clearance Survey from the 6th Tromsø Study (RENIS-T6) between 2007 and 2009. Obesity was assessed using the body mass index (BMI), waist circumference (WC) and the waist-hip ratio (WHR). GFR was measured by iohexol clearance. Dichotomous variables for hyperfiltration were based on two alternative definitions using unadjusted GFR (mL/min) above the 90th percentile. The 90th percentile was age-, sex- and height-specific in one definition and age-, sex-, height- and weight-specific in the other. Results In multivariable adjusted logistic regression models, only WHR was consistently associated with hyperfiltration based on both definitions. For the definition based on the age-, sex-, height- and weight-specific 90th percentile, the association with the WHR (odds ratios (95 % confidence intervals)) for hyperfiltration was 1.48 (1.08–2.02) per 0.10 WHR increase. Conclusions Central obesity is associated with hyperfiltration in the general population. The WHR may serve as a better indicator of the renal effects of obesity than BMI or WC. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0386-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vidar Tor Nyborg Stefansson
- Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Jørgen Schei
- Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Trond Geir Jenssen
- Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Organ Transplantation, Oslo University Hospital, Oslo, Norway
| | - Toralf Melsom
- Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
| | - Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
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36
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Smit M, Werner MJM, Lansink-Hartgring AO, Dieperink W, Zijlstra JG, van Meurs M. How central obesity influences intra-abdominal pressure: a prospective, observational study in cardiothoracic surgical patients. Ann Intensive Care 2016; 6:99. [PMID: 27726116 PMCID: PMC5056912 DOI: 10.1186/s13613-016-0195-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/18/2016] [Indexed: 01/17/2023] Open
Abstract
Background Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood. Increased IAP may be a link in this association. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relationship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population. Methods Consecutive adult patients admitted to the cardiothoracic unit of the intensive care unit (ICU) after undergoing elective cardiothoracic surgery were included in this prospective, observational study. C-reactive protein (CRP) as a marker of inflammation and serum creatinine as a marker of renal function were measured pre- and postoperatively. Estimated glomerular filtration rates were calculated pre- and postoperatively. BMI was calculated. Waist circumference (WC), hip circumference (HC) and transvesical IAP were measured once directly after admission to the ICU postoperatively. Waist/hip ratio (WHR) was calculated (WC divided by HC). Three definitions of central obesity were used. Central obesity was defined according to WC, WHR or median WHR. Results In total, 186 patients undergoing cardiothoracic surgery were included. Mean IAP was 9.1 mmHg (SD 4.4). IAP ≥ 12 mmHg was observed in 50 patients (26.9 %). IAP > 20 mmHg was measured in 4 patients (2.2 %). There was a positive correlation between IAP and BMI (r2 = 0.05, p = 0.003). Correlations between IAP and WC (r2 = 0.02, p = 0.054) and between IAP and WHR (r2 = 0.01, p = 0.173) were not significant. There were no correlations between pre- or postoperative CRP and IAP (r2 = 2.3 × 10−4, p = 0.839 and r2 = 0.013, p = 0.117, respectively). In obese patients postoperative CRP was significantly higher than in non-obese patients (p = 0.034). There were no correlations between pre-operative serum creatinine and IAP (r2 = 3.3 × 10−5, p = 0.938) or postoperative serum creatinine and IAP (r2 = 0.003, p = 0.491). Conclusions The range in IAP in patients undergoing cardiothoracic surgery was wide. There was a positive correlation between IAP and BMI. Correlations between IAP and indices for central obesity were not significant. In a multiple regression model BMI was a better predictor of IAP than WHR in this population. There were no correlations between pre- or postoperative CRP and IAP. Furthermore, this study did not find evidence for a relation between IAP and pre- and postoperative serum creatinine. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0195-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marije Smit
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Maureen J M Werner
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Annemieke Oude Lansink-Hartgring
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Willem Dieperink
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care (BA 49), University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
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Sarathy H, Henriquez G, Abramowitz MK, Kramer H, Rosas SE, Johns T, Kumar J, Skversky A, Kaskel F, Melamed ML. Abdominal Obesity, Race and Chronic Kidney Disease in Young Adults: Results from NHANES 1999-2010. PLoS One 2016; 11:e0153588. [PMID: 27224643 PMCID: PMC4880194 DOI: 10.1371/journal.pone.0153588] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/31/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Kidney dysfunction in obesity may be independent of and may precede the development of hypertension and/or diabetes mellitus. We aimed to examine if abdominal obesity is associated with early markers of CKD in a young healthy population and whether these associations differ by race and/or ethnicity. METHODS We analyzed data from the NHANES 1999-2010 for 6918 young adults ages 20-40 years. Abdominal obesity was defined by gender criteria of waist circumference. CKD markers included estimated glomerular filtration rate and albuminuria ≥30 mg/g. Race stratified analyses were done overall and in subgroups with normal blood pressures, normoglycemia and normal insulin sensitivity. Awareness of CKD was assessed in participants with albuminuria. RESULTS Abdominal obesity was present in over one-third of all young adults and was more prevalent among non-Hispanic blacks (45.4%) versus Mexican-Americans (40.6%) or non-Hispanic whites (37.4%) (P-value = 0.004). Mexican-American young adults with abdominal obesity had a higher odds of albuminuria even among those with normal blood pressure, normal glucose, and normal insulin sensitivity [adjusted odds ratio 4.5; 95% confidence interval (1.6-12.2), p = 0.004]. Less than 5% of young adults with albuminuria of all races and ethnicities had been told they had kidney disease. CONCLUSION Abdominal obesity in young adults, especially in Mexican-Americans, is independently associated with albuminuria even with normal blood pressures, normoglycemia and normal insulin levels. Greater awareness of CKD is needed to protect this young population from long-standing exposure to abdominal obesity and early progressive renal disease.
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Affiliation(s)
- Harini Sarathy
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
| | - Gabriela Henriquez
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
- Department of Pediatrics, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
| | - Matthew K. Abramowitz
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Holly Kramer
- Departments of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola University Health Sciences Center, Maywood, Illinois, United States of America
| | - Sylvia E. Rosas
- Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Tanya Johns
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
| | - Juhi Kumar
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States of America
| | - Amy Skversky
- Department of Pediatrics, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
| | - Frederick Kaskel
- Department of Pediatrics, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
| | - Michal L. Melamed
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Chew-Harris JSC, Florkowski CM, Elmslie JL, Livesey J, Endre ZH, George PM. Lean mass modulates glomerular filtration rate in males of normal and extreme body composition. Intern Med J 2015; 44:749-56. [PMID: 24863461 DOI: 10.1111/imj.12479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/05/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Understanding determinants of glomerular filtration rate (GFR) is important in aiding prediction and interpretation of kidney function. Body composition is known to affect GFR but is not included in current screening of kidney disease. We investigated the association between GFR and body composition in healthy young men with differing body mass but without known diabetes or kidney injury. METHODS Three groups were recruited: normal BMI (n = 22) with a body mass index (BMI) <25 kg/m(2) , muscular (n = 23) with BMI ≥30 kg/m(2) and bioelectrical impedance body fat ≤20% and obese (n = 22) with BMI ≥30 kg/m(2) and bioelectrical impedance body fat ≥30%. Dietary analyses, GFR clearance by (99m) Tc-DTPA, urine protein and body composition by dual-energy X-ray absorptiometry were measured in all participants. Linear and nonlinear associations of constituents of body composition with GFR were assessed. RESULTS Muscular men had a higher GFR (mean 186.4 mL/min; 95% CI 171.7-201.1) than normal BMI and obese groups (P = 0.0007). Urine protein and albumin excretion were not elevated in any participants. On multiple regression analysis (r(2) = 0.60), the variables with strong associations with GFR were age (P = 0.0009) and lean mass (P = 0.0001). Fat mass, protein intake and smoking status were not associated. Skeletal muscle mass correlated significantly with GFR in all subgroups. CONCLUSION Age and lean mass were strong determinants of GFR. Estimates of GFR should therefore be indexed to an estimate of lean mass.
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Affiliation(s)
- J S C Chew-Harris
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand; Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
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Lee J, Kim HJ, Cho B, Park JH, Choi HC, Lee CM, Oh SW, Kwon H, Heo NJ. Abdominal Adipose Tissue was Associated with Glomerular Hyperfiltration among Non- Diabetic and Normotensive Adults with a Normal Body Mass Index. PLoS One 2015; 10:e0141364. [PMID: 26495973 PMCID: PMC4619835 DOI: 10.1371/journal.pone.0141364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/06/2015] [Indexed: 01/10/2023] Open
Abstract
Glomerular hyperfiltration is recognized as an early marker of progressive kidney dysfunction in the obese population. This study aimed to identify the relationship between glomerular hyperfiltration and body fat distribution measured by computed tomography (CT) in healthy Korean adults. The study population included individuals aged 20-64 years who went a routine health check-up including an abdominal CT scan. We selected 4,378 individuals without diabetes and hypertension. Glomerular filtration rate was estimated using the CKD-EPI equation, and glomerular hyperfiltration was defined as the highest quintile of glomerular filtration rate. Abdominal adipose tissue areas were measured at the level of the umbilicus using a 16-detector CT scanner, and the cross-sectional area was calculated using Rapidia 2.8 CT software. The prevalence of glomerular hyperfiltration increased significantly according to the subcutaneous adipose tissue area in men (OR = 1.74 (1.16-2.61), P for trend 0.016, for the comparisons of lowest vs. highest quartile) and visceral adipose tissue area in women (OR = 2.34 (1.46-3.75), P for trend < 0.001) in multivariate analysis. After stratification by body mass index (normal < 23 kg/m2, overweight ≥ 23 kg/m2), male subjects with greater subcutaneous adipose tissue, even those in the normal BMI group, had a higher prevalence of glomerular hyperfiltration (OR = 2.11 (1.17-3.80), P for trend = 0.009). Among women, the significance of visceral adipose tissue area on glomerular hyperfiltration resulted from the normal BMI group (OR = 2.14 (1.31-3.49), P for trend = 0.002). After menopause, the odds ratio of the association of glomerular hyperfiltration with subcutaneous abdominal adipose tissue increased (OR = 2.96 (1.21-7.25), P for trend = 0.013). Subcutaneous adipose tissue areas and visceral adipose tissue areas are positively associated with glomerular hyperfiltration in healthy Korean adult men and women, respectively. In post-menopausal women, visceral adipose tissue area shows significant positive association with glomerular hyperfiltration as in men.
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Affiliation(s)
- Jeonghwan Lee
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Hye Jin Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho Chun Choi
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
| | - Seung Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Healthcare System Gangnam Center of Seoul National University Hospital, Seoul, South Korea
- * E-mail: (NJH); (HK)
| | - Nam Ju Heo
- Subdivision of Nephrology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
- * E-mail: (NJH); (HK)
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40
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Zingerman B, Herman-Edelstein M, Erman A, Bar Sheshet Itach S, Ori Y, Rozen-Zvi B, Gafter U, Chagnac A. Effect of Acetazolamide on Obesity-Induced Glomerular Hyperfiltration: A Randomized Controlled Trial. PLoS One 2015; 10:e0137163. [PMID: 26367377 PMCID: PMC4569381 DOI: 10.1371/journal.pone.0137163] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022] Open
Abstract
AIMS Obesity is an important risk factor for the development of chronic kidney disease. One of the major factors involved in the pathogenesis of obesity-associated kidney disease is glomerular hyperfiltration. Increasing salt-delivery to the macula densa is expected to decrease glomerular filtration rate (GFR) by activating tubuloglomerular feedback. Acetazolamide, a carbonic anhydrase inhibitor which inhibits salt reabsorption in the proximal tubule, increases distal salt delivery. Its effects on obesity-related glomerular hyperfiltration have not previously been studied. The aim of this investigation was to evaluate whether administration of acetazolamide to obese non diabetic subjects reduces glomerular hyperfiltration. MATERIALS AND METHODS The study was performed using a randomized double-blind crossover design. Obese non-diabetic men with glomerular hyperfiltration were randomized to receive intravenously either acetazolamide or furosemide at equipotent doses. Twelve subjects received the allocated medications. Two weeks later, the same subjects received the drug which they had not received during the first study. Inulin clearance, p-aminohippuric acid clearance and fractional lithium excretion were measured before and after medications administration. The primary end point was a decrease in GFR, measured as inulin clearance. RESULTS GFR decreased by 21% following acetazolamide and did not decrease following furosemide. Renal vascular resistance increased by 12% following acetazolamide, while it remained unchanged following furosemide administration. Natriuresis increased similarly following acetazolamide and furosemide administration. Sodium balance was similar in both groups. CONCLUSIONS Intravenous acetazolamide decreased GFR in obese non-diabetic men with glomerular hyperfiltration. Furosemide, administered at equipotent dose, did not affect GFR, suggesting that acetazolamide reduced glomerular hyperfiltration by activating tubuloglomerular feedback. TRIAL REGISTRATION ClinicalTrials.gov NCT01146288.
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Affiliation(s)
- Boris Zingerman
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Herman-Edelstein
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Erman
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yaacov Ori
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uzi Gafter
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avry Chagnac
- Department of Nephrology & Hypertension, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
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41
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Lu JL, Molnar MZ, Naseer A, Mikkelsen MK, Kalantar-Zadeh K, Kovesdy CP. Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol 2015; 3:704-14. [PMID: 26235959 PMCID: PMC4547884 DOI: 10.1016/s2213-8587(15)00128-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Compared with normal weight, obesity might be associated with worse clinical outcomes, including chronic kidney disease. Whether this association is modified by age is not known. We investigated the association of BMI with progressive loss of kidney function and all-cause mortality in US veterans. METHODS In a national cohort of 3,376,187 US veterans with an estimated glomerular filtration rate (eGFR) of more than 60 mL/min per 1·73 m(2), we assessed the association of BMI in patients of different ages (<40 years, 40 years to <50 years, 50 years to <60 years, 60 years to <70 years, 70 years to <80 years, and ≥80 years) with loss of kidney function and with all-cause mortality in logistic regression models and Cox proportional hazards models adjusted for ethnic origin, sex, comorbidities, medications, and baseline eGFR. FINDINGS 274,764 (8·1%) of 3,376,187 veterans had a rapid decline in kidney function (decrease in slope of >5 mL/min per 1·73 m(2)). The lowest risk for loss of kidney function was noted in patients with BMI of at least 25 kg/m(2) but less than 30 kg/m(2). A generally consistent U-shaped association was noted between BMI and rapid loss of kidney function that was more prominent with increasing age, except in the patients younger than 40 years, in whom BMI did not seem to be predictive of renal function impairment. 672,341 veterans died (28·7 per 1000 patient-years, 95% CI 28·6-28·7) over a median follow-up of 6·8 years (IQR 6·5-7·7). BMI also showed a U-shaped association with mortality, which was similar in all age groups. INTERPRETATION A BMI of 30 kg/m(2) or more is associated with rapid loss of kidney function in patients with eGFR of at least 60 mL/min per 1·73 m(2), and this association is accentuated in older patients. A BMI of 35 kg/m(2) or more is also associated with high mortality. A BMI of at least 25 kg/m(2) but less than 30 kg/m(2) is associated with the best clinical outcomes. FUNDING National Institute of Health, Memphis VA Medical Center, Long Beach VA Healthcare System, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center.
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Affiliation(s)
- Jun Ling Lu
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adnan Naseer
- Division of Nephrology, Memphis Veteran Affairs Medical Center, Memphis, TN, USA
| | - Margit K Mikkelsen
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Nephrology, Memphis Veteran Affairs Medical Center, Memphis, TN, USA.
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Favre G, Schneck AS, Anty R, Esnault VLM, Iannelli A. Improvement of Kidney Function Following Bariatric Surgery: Hope or Illusion? Obes Surg 2015. [PMID: 26220237 DOI: 10.1007/s11695-015-1819-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Favre
- INSERM, U 1081, CNRS, UMR 7284, "Aging and Diabetes" Team, Institute for Research on Cancer and Aging of Nice (IRCAN), Nice, France,
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Huang J, Zhou C, Li Y, Zhu S, Liu A, Shao X, Liu X, Holthfer H, Zou H. Visceral adiposity index, hypertriglyceridemic waist phenotype and chronic kidney disease in a southern Chinese population: a cross-sectional study. Int Urol Nephrol 2015; 47:1387-96. [PMID: 26149635 DOI: 10.1007/s11255-015-1040-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/18/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore the relationships between visceral adiposity index (VAI), hypertriglyceridemic waist phenotype (HW phenotype) and chronic kidney disease (CKD). METHODS A cross-sectional study was conducted in Zhuhai City June-October 2012. A total of 2142 participants were recruited. Logistic regression was used to evaluate the associations between VAI, HW phenotype and CKD. RESULTS After adjustment for age, VAI was significantly associated with CKD (OR 2.16, 95 % CI 1.25-3.74, P = 0.006) in women. Further adjusted for potential confounders, the association was still significant in women (OR 2.07, 95 % CI 1.17-3.64, P = 0.01). However, the association was abolished when adding diabetes and hypertension to the model (OR 1.68, 95 % CI 0.92-3.06, P = 0.09). The age-adjusted OR (95 % CI, P) of CKD associated with HW phenotype was 2.21 (1.29-3.76, 0.004) and 2.54 (1.53-4.22, <0.001) for men and women, respectively. Further adjusted for potential confounders, the associations were still significant in both subgroups. The OR for CKD was 2.41 (95 % CI 1.42-4.12, P = 0.001) and 2.32 (95 % CI 1.31-4.11, P = 0.004) for women and men, respectively. When further adjusted for diabetes and hypertension, the association of HW phenotype and CKD was significant (OR 1.88, 95 % CI 1.05-3.36, P = 0.033) in women. However, the model is abolished in men (OR 1.50, 95 % CI 0.81-2.78, P = 0.19). CONCLUSION Our results suggest that both VAI and the HW phenotype might be useful clinical indicators of CKD in China for females but not for males. The HW phenotype associated more strongly with CKD, compared with VAI.
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Affiliation(s)
- Jun Huang
- Department of Nephronology, Institute of Nephronology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
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44
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Chang A, Greene TH, Wang X, Kendrick C, Kramer H, Wright J, Astor B, Shafi T, Toto R, Lewis J, Appel LJ, Grams M. The effects of weight change on glomerular filtration rate. Nephrol Dial Transplant 2015; 30:1870-7. [PMID: 26085555 DOI: 10.1093/ndt/gfv219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/10/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about the effect of weight loss/gain on kidney function. Analyses are complicated by uncertainty about optimal body surface indexing strategies for measured glomerular filtration rate (mGFR). METHODS Using data from the African-American Study of Kidney Disease and Hypertension (AASK), we determined the association of change in weight with three different estimates of change in kidney function: (i) unindexed mGFR estimated by renal clearance of iodine-125-iothalamate, (ii) mGFR indexed to concurrently measured BSA and (iii) GFR estimated from serum creatinine (eGFR). All models were adjusted for baseline weight, time, randomization group and time-varying diuretic use. We also examined whether these relationships were consistent across a number of subgroups, including tertiles of baseline 24-h urine sodium excretion. RESULTS In 1094 participants followed over an average of 3.6 years, a 5-kg weight gain was associated with a 1.10 mL/min/1.73 m(2) (95% CI: 0.87 to 1.33; P < 0.001) increase in unindexed mGFR. There was no association between weight change and mGFR indexed for concurrent BSA (per 5 kg weight gain, 0.21; 95% CI: -0.02 to 0.44; P = 0.1) or between weight change and eGFR (-0.09; 95% CI: -0.32 to 0.14; P = 0.4). The effect of weight change on unindexed mGFR was less pronounced in individuals with higher baseline sodium excretion (P = 0.08 for interaction). CONCLUSION The association between weight change and kidney function varies depending on the method of assessment. Future clinical trials should examine the effect of intentional weight change on measured GFR or filtration markers robust to changes in muscle mass.
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Affiliation(s)
- Alex Chang
- Division of Nephrology, Geisinger Health System, Danville, PA, USA
| | - Tom H Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Xuelei Wang
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, USA
| | - Cynthia Kendrick
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Holly Kramer
- Division of Nephrology, Loyola University Medical Center, Maywood, NJ, USA
| | - Jackson Wright
- Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA
| | - Brad Astor
- Division of Nephrology, University of Wisconsin, Madison, WI, USA
| | - Tariq Shafi
- School of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Toto
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julia Lewis
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lawrence J Appel
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Morgan Grams
- School of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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45
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Park M. Islands in the stream: the risk of kidney disease from cardiovascular disease. Am J Kidney Dis 2015; 65:647-9. [PMID: 25919498 DOI: 10.1053/j.ajkd.2015.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Meyeon Park
- University of California, San Francisco, San Francisco, California.
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46
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Toering TJ, van der Graaf AM, Visser FW, Groen H, Faas MM, Navis G, Lely AT. Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity. Am J Physiol Renal Physiol 2015; 308:F824-31. [PMID: 25694481 DOI: 10.1152/ajprenal.00536.2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/08/2015] [Indexed: 11/22/2022] Open
Abstract
Formerly preeclamptic women have an increased risk for developing end-stage renal disease, which has been attributed to altered renal hemodynamics and abnormalities in the renin-angiotensin-aldosterone system. Whether this is due to preeclampsia itself or to comorbid conditions is unknown. Renal hemodynamics and responsiveness to ANG II during low Na(+) intake (7 days, 50 mmol Na(+)/24 h) and high Na(+) (HS) intake (7 days, 200 mmol Na(+)/24 h) were studied in 18 healthy normotensive formerly early-onset preeclamptic women (fPE women) and 18 healthy control subjects (fHP women), all selected for absence of comorbidity. At the end of each diet, renal hemodynamics and blood pressure were measured before and during graded ANG II infusion. Both HS intake and former preeclampsia increased filtration fraction (FF) without an interaction between the two. FF was highest during HS intake in fPE women [0.31 ± 0.12 vs. 0.29 ± 0.11 in fHP women, generalized estimating equation analysis (body mass index corrected), P = 0.03]. The renal response to ANG II infusion was not different between groups. In conclusion, fPE women have a higher FF compared with fHP women. As this was observed in the absence of comorbidity, preeclampsia itself might exert long-term effects on renal hemodynamics. However, we cannot exclude the presence of prepregnancy alterations in renal function, which, in itself, lead to an increased risk for preeclampsia. In experimental studies, an elevated FF has been shown to play a pathogenic role in the development of hypertension and renal damage. Future studies, however, should evaluate whether the subtle differences in renal hemodynamics after preeclampsia contribute to the increased long-term renal risk after preeclampsia.
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Affiliation(s)
- Tsjitske J Toering
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anne Marijn van der Graaf
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Folkert W Visser
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; and
| | - Marijke M Faas
- Department of Pathology and Medical Biology, Division of Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Titia Lely
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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47
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Kwakernaak AJ, Toering TJ, Navis G. Body mass index and body fat distribution as renal risk factors: a focus on the role of renal haemodynamics. Nephrol Dial Transplant 2014; 28 Suppl 4:iv42-9. [PMID: 24179015 DOI: 10.1093/ndt/gft331] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Weight excess and/or central body fat distribution are associated with increased long-term renal risk, not only in subjects with renal disease or renal transplant recipients, but also in the general population. As the prevalence of weight excess is rising worldwide, this may become a main renal risk factor on a population basis, even more so because the risk extends to the overweight range. Understanding the mechanisms of this detrimental effect of weight excess on the kidneys is needed in order to design preventive treatment strategies. The increased risk associated with weight excess is partly attributed to associated comorbid conditions, such as hypertension, dyslipidaemia, insulin resistance and diabetes; however, current evidence supports a direct pathogenetic role for renal haemodynamics as well. Weight excess is associated with an altered renal haemodynamic profile, i.e. an increased glomerular filtration rate relative to effective renal plasma flow, resulting in an increased filtration fraction (FF). This renal haemodynamic profile is considered to reflect glomerular hyperfiltration and glomerular hypertension, resulting from a dysbalance between afferent and efferent arterial vasomotor balance. This unfavorable renal haemodynamic profile was found to be associated with renal outcome in experimental models and in human renal transplant recipients, and is associated with a blunted sodium excretion, and reversible by weight loss, renin-angiotensin-aldosterone system blockade or by dietary sodium restriction. More recent evidence showed that a central body fat distribution is also associated with an increased FF, even independent of overall weight excess. In this review, we provide an overview on current literature on the impact of weight excess and central body fat distribution on the renal haemodynamic profile in humans, and its possible role in progressive renal damage.
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Affiliation(s)
- Arjan J Kwakernaak
- Division of Nephrology, Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001680. [PMID: 25050550 PMCID: PMC4106719 DOI: 10.1371/journal.pmed.1001680] [Citation(s) in RCA: 450] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 06/12/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a frequent, under-recognized condition and a risk factor for renal failure and cardiovascular disease. Increasing evidence connects non-alcoholic fatty liver disease (NAFLD) to CKD. We conducted a meta-analysis to determine whether the presence and severity of NAFLD are associated with the presence and severity of CKD. METHODS AND FINDINGS English and non-English articles from international online databases from 1980 through January 31, 2014 were searched. Observational studies assessing NAFLD by histology, imaging, or biochemistry and defining CKD as either estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or proteinuria were included. Two reviewers extracted studies independently and in duplicate. Individual participant data (IPD) were solicited from all selected studies. Studies providing IPD were combined with studies providing only aggregate data with the two-stage method. Main outcomes were pooled using random-effects models. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. The influences of age, whole-body/abdominal obesity, homeostasis model of insulin resistance (HOMA-IR), and duration of follow-up on effect estimates were assessed by meta-regression. Thirty-three studies (63,902 participants, 16 population-based and 17 hospital-based, 20 cross-sectional, and 13 longitudinal) were included. For 20 studies (61% of included studies, 11 cross-sectional and nine longitudinal, 29,282 participants), we obtained IPD. NAFLD was associated with an increased risk of prevalent (odds ratio [OR] 2.12, 95% CI 1.69-2.66) and incident (hazard ratio [HR] 1.79, 95% CI 1.65-1.95) CKD. Non-alcoholic steatohepatitis (NASH) was associated with a higher prevalence (OR 2.53, 95% CI 1.58-4.05) and incidence (HR 2.12, 95% CI 1.42-3.17) of CKD than simple steatosis. Advanced fibrosis was associated with a higher prevalence (OR 5.20, 95% CI 3.14-8.61) and incidence (HR 3.29, 95% CI 2.30-4.71) of CKD than non-advanced fibrosis. In all analyses, the magnitude and direction of effects remained unaffected by diabetes status, after adjustment for other risk factors, and in other subgroup and meta-regression analyses. In cross-sectional and longitudinal studies, the severity of NAFLD was positively associated with CKD stages. Limitations of analysis are the relatively small size of studies utilizing liver histology and the suboptimal sensitivity of ultrasound and biochemistry for NAFLD detection in population-based studies. CONCLUSION The presence and severity of NAFLD are associated with an increased risk and severity of CKD. Please see later in the article for the Editors' Summary.
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de Vries APJ, Ruggenenti P, Ruan XZ, Praga M, Cruzado JM, Bajema IM, D'Agati VD, Lamb HJ, Pongrac Barlovic D, Hojs R, Abbate M, Rodriquez R, Mogensen CE, Porrini E. Fatty kidney: emerging role of ectopic lipid in obesity-related renal disease. Lancet Diabetes Endocrinol 2014; 2:417-26. [PMID: 24795255 DOI: 10.1016/s2213-8587(14)70065-8] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The global increase in chronic kidney disease (CKD) parallels the obesity epidemic. Obesity conveys a gradual but independent risk of progression of CKD that seems irrespective of the underlying nephropathy. Obesity has been associated with a secondary focal segmental glomerulosclerosis coined obesity-related glomerulopathy (ORG). Pathways through which obesity might cause renal disease are not well understood, and early clinical biomarkers for incipient ORG or renal relevant obesity are currently lacking. Recent human and experimental studies have associated ectopic lipid accumulation in the kidney (fatty kidney) with obesity-related renal disease. There is enough growing insight that ectopic lipid--the accumulation of lipid in non-adipose tissue--is associated with structural and functional changes of mesangial cells, podocytes, and proximal tubular cells to propose the development of ORG as a maladaptive response to hyperfiltration and albuminuria. Recent advances in metabolic imaging might validate ectopic lipid as a biomarker and research aid, to help translate novel therapeutics from experimental models to patients.
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Affiliation(s)
- Aiko P J de Vries
- Department of Nephrology, Leiden University Medical Center and Leiden University, Leiden, Netherlands.
| | - Piero Ruggenenti
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Bergamo, Italy; Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Xiong Z Ruan
- Moorhead Renal Research Laboratory, University College London, Royal Free Campus, London, UK; Centre for Nephrology and Urology, Shenzhen University Health Science Centre, Shenzhen, China
| | - Manuel Praga
- Departments of Nephrology and Medicine, Hospital 12 de Octubre, Complutense University, Madrid, Spain
| | - Josep M Cruzado
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Center and Leiden University, Leiden, Netherlands
| | - Vivette D D'Agati
- Department of Pathology, Columbia University Medical Center, New York, NY, USA
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center and Leiden University, Leiden, Netherlands
| | - Drazenka Pongrac Barlovic
- Department of Endocrinology, Diabetes and Metabolism, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Clinical Centre and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Manuela Abbate
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Bergamo, Italy
| | - Rosa Rodriquez
- Department of Pathology, Hospital Universitario de Canarias, Tenerife
| | | | - Esteban Porrini
- Center for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna, Tenerife, Spain
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Li Y, Zhou C, Shao X, Liu X, Guo J, Zhang Y, Wang H, Wang X, Li B, Deng K, Liu Q, Holthöfer H, Zou H. Hypertriglyceridemic waist phenotype and chronic kidney disease in a Chinese population aged 40 years and older. PLoS One 2014; 9:e92322. [PMID: 24663403 PMCID: PMC3963886 DOI: 10.1371/journal.pone.0092322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/20/2014] [Indexed: 12/22/2022] Open
Abstract
Objective To examine the relationship between the HW phenotype and risk for CKD in a community population aged 40 years and older. Methods A cross-sectional study was conducted in Zhuhai from June to October 2012. The participants were divided into three groups: Group 1, Waist circumference >90 cm in men or >85 cm in women and triglycerides ≥2 mmol/l; Group 3, Waist circumference ≤90 cm in men or ≤85 cm in women and triglycerides <2 mmol/l; Group 2, The remaining participants. The prevalence of the three subgroups and CKD were determined. The association between HW phenotype and CKD was then analyzed using SPSS (version 13.0). Results After adjusting for age and sex, Group 1 was associated with CKD (OR 3.08, 95% CI 2.01, 4.73, P<0.001), when compared with Group 3. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between the HW phenotype and CKD, Group 1 was still significantly associated with CKD. The OR for CKD was 2.65 (95% CI 1.65, 4.26, P<0.001). When adjusted for diabetes and hypertension, the association of Group 1 and CKD was still significant (OR 2.09, 95% CI 1.26, 3.45, P = 0.004). Group 2 was associated with CKD (OR 1.81, 95% CI 1.29, 2.53, P = 0.001), when compared with Group 3. Further adjustment for factors which were potential confounders, Group 2 was still significantly associated with CKD. The OR for CKD was 1.75 (95% CI 1.22, 2.51, P = 0.002). When adjusted for diabetes and hypertension, the association between Group 2 and CKD still existed. The OR for CKD was 1.48 (95% CI 1.01, 2.16, P = 0.046). Conclusion Our results showed that HW phenotype was associated with CKD in the population aged 40 years and older.
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Affiliation(s)
- Yongqiang Li
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chaomin Zhou
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaofei Shao
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinyu Liu
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jia Guo
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Ying Zhang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Honglei Wang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohong Wang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Li
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kangping Deng
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qin Liu
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Harry Holthöfer
- National Centre for Sensor Research/BioAnalytical Sciences, Dublin City University, Dublin, Ireland
| | - Hequn Zou
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail:
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