1
|
Kim A, Lee CM, Kang BK, Kim M, Choi JW. Myosteatosis and aortic calcium score on abdominal CT as prognostic markers in non-dialysis chronic kidney disease patients. Sci Rep 2024; 14:7718. [PMID: 38565556 PMCID: PMC10987640 DOI: 10.1038/s41598-024-58293-3] [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: 10/16/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Abstract
We aimed to examine the relationship between abdominal computed tomography (CT)-based body composition data and both renal function decline and all-cause mortality in patients with non-dialysis chronic kidney disease (CKD). This retrospective study comprised non-dialysis CKD patients who underwent consecutive unenhanced abdominal CT between January 2010 and December 2011. CT-based body composition was measured using semiautomated method that included visceral fat, subcutaneous fat, skeletal muscle area and density, and abdominal aortic calcium score (AAS). Sarcopenia and myosteatosis were defined by decreased skeletal muscle index (SMI) and decreased skeletal muscle density, respectively, each with specific cutoffs. Risk factors for CKD progression and survival were identified using logistic regression and Cox proportional hazard regression models. Survival between groups based on myosteatosis and AAS was compared using the Kaplan-Meier curve. 149 patients (median age: 70 years) were included; 79 (53.0%) patients had sarcopenia and 112 (75.2%) had myosteatosis. The median AAS was 560.9 (interquartile range: 55.7-1478.3)/m2. The prognostic factors for CKD progression were myosteatosis [odds ratio (OR) = 4.31, p = 0.013] and high AAS (OR = 1.03, p = 0.001). Skeletal muscle density [hazard ratio (HR) = 0.93, p = 0.004] or myosteatosis (HR = 4.87, p = 0.032) and high AAS (HR = 1.02, p = 0.001) were independent factors for poor survival outcomes. The presence of myosteatosis and the high burden of aortic calcium were significant factors for CKD progression and survival in patients with non-dialysis CKD.
Collapse
Affiliation(s)
- Ahyun Kim
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Bo-Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Mimi Kim
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Jong Wook Choi
- Department of Internal Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Ng JKC, Chan GCK, Kam KKH, Tian N, Than WH, Cheng PMS, Law MC, Pang WF, Szeto CC, Li PKT. The Impact of Volume Overload on the Longitudinal Change of Adipose and Lean Tissue Mass in Incident Chinese Peritoneal Dialysis Patients. Nutrients 2022; 14:nu14194076. [PMID: 36235728 PMCID: PMC9571726 DOI: 10.3390/nu14194076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Patients treated with peritoneal dialysis (PD) experience complex body composition changes that are not adequately reflected by traditional anthropometric parameters. While lean and adipose tissue mass can be readily assessed by bioimpedance spectroscopy (BIS), there is concern about the potential confounding effect of volume overload on these measurements. This study aimed to assess the influence of fluid status (by echocardiography) on body composition parameters measured by BIS and to describe the longitudinal changes in adipose and lean tissue mass. We conducted a prospective observational study in a tertiary hospital. Incident Chinese PD patients underwent baseline echocardiography and repeated BIS measurements at baseline and 12 months later. Among 101 PD patients, lean tissue index (LTI) or fat tissue index (FTI) was not associated with echocardiographic parameters that reflected left ventricular filling pressure (surrogate of volume status). Sixty-eight patients with repeated BIS had a significant increase in body weight and FTI, while LTI remained similar. Gains in fat mass were significantly associated with muscle wasting (beta = −0.71, p < 0.0001). Moreover, progressive fluid accumulation independently predicted decrease in FTI (beta = −0.35, p < 0.0001) but not LTI. Body composition assessments by BIS were not affected by fluid status and should be considered as part of comprehensive nutrition assessment in PD patients.
Collapse
Affiliation(s)
- Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Gordon Chun-Kau Chan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Kevin Ka-Ho Kam
- Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong 999077, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Win Hlaing Than
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Phyllis Mei-Shan Cheng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Man-Ching Law
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Wing-Fai Pang
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Cheuk-Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence:
| |
Collapse
|
3
|
Suzuki N, Hitomi Y, Takata H, Ushiya S, Yamada M, Sakai Y, Konishi T, Takeda Y, Sumino Y, Mizo M, Tsuji Y, Nishimura M, Hashimoto T, Kobayashi H. Association between salt intake and long-term mortality in hemodialysis patients: A retrospective cohort study. PLoS One 2021; 16:e0260671. [PMID: 34914719 PMCID: PMC8675678 DOI: 10.1371/journal.pone.0260671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background The association between salt intake and clinical outcomes in hemodialysis patients has been controversial. This study aimed to clarify the association between salt intake and mortality in hemodialysis patients. Method The present study included patients who underwent hemodialysis from June 1st 2016 to May 31st 2020. Corrected salt intake by ideal body weight was the main predictor of outcomes. Ideal body weight was calculated assuming that the ideal body mass index is 22 kg/m2 for the Japanese population. The multivariate Cox proportional hazards model was used to determine the association between corrected salt intake and mortality, adjusting for potential confounders. The outcomes considered were all-cause mortality and cumulative incidence of cardiovascular events at year 4. Result A total of 492 adult patients were enrolled in the study. The mean daily salt intake and corrected salt intake at baseline were 9.5 g/day and 0.17 g/kg/day, respectively. The low corrected salt intake group (< 0.13 g/kg/day) demonstrated the highest 4-year all-cause mortality. No association was observed between corrected salt intake and the cumulative incidence of cardiovascular events. In multivariate Cox proportional hazards analysis, only the group with corrected salt intake of 0.16–0.20 g/kg/day was associated with a decreased hazard risk for all-cause death compared with the low corrected salt intake group. Conclusion The present study found that a low salt intake was associated with high all-cause mortality in hemodialysis patients. Reduced long-term survival may be attributed to malnutrition resulting from excessive salt restriction.
Collapse
Affiliation(s)
- Naoki Suzuki
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
- * E-mail:
| | - Yasumasa Hitomi
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Hiroya Takata
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Shinji Ushiya
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Masahiro Yamada
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yusuke Sakai
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Takahiro Konishi
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yuuki Takeda
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yuuki Sumino
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Masaya Mizo
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yoshihiro Tsuji
- Faculty of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | | | | | | |
Collapse
|
4
|
Bichels AV, Cordeiro AC, Avesani CM, Amparo FC, Giglio J, Souza NC, Pinho N, Amodeo C, Carrero JJ, Lindholm B, Stenvinkel P, Kamimura MA. Muscle Mass Assessed by Computed Tomography at the Third Lumbar Vertebra Predicts Patient Survival in Chronic Kidney Disease. J Ren Nutr 2021; 31:342-350. [DOI: 10.1053/j.jrn.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/20/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
|
5
|
Bellafronte NT, de Queirós Mattoso Ono A, Chiarello PG. Sarcopenic Obesity in Chronic Kidney Disease: Challenges in Diagnosis Using Different Diagnostic Criteria. Med Princ Pract 2021; 30:477-486. [PMID: 34082433 PMCID: PMC8562051 DOI: 10.1159/000517597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Obesity, muscle impairment (low muscle mass or strength), and sarcopenic obesity are present in chronic kidney disease (CKD) and are associated with worse clinical prognosis. However, the various existing definitions for these conditions make the diagnosis variable. The aim of the present study was to evaluate the agreement between diagnostic criteria for sarcopenic obesity and its components in CKD. SUBJECT AND METHODS 267 patients with CKD were included in the study. We assessed body composition by dual-energy X-ray absorptiometry and muscle function by handgrip strength (HGS) and adiposity by body mass index (BMI), waist circumference (WC), fat mass index (FMI), and percentage of FM. Diagnosis of muscle impairment was made by HGS, appendicular lean mass (ALM), and ALM index; obesity by BMI, WC, FMI, and %FM, and sarcopenic obesity was diagnosed by concomitant presence of muscle impairment and obesity. RESULTS Prevalence of muscle impairment varied from 11 to 50%, higher when low muscle mass criteria were used. Prevalence of obesity varied from 26 to 62%, higher when WC and %FM criteria were used. Prevalence of sarcopenic obesity varied from 2 to 23%. Women were more affected by sarcopenic obesity. Muscle impairment and sarcopenic obesity were more prevalent among patients on hemodialysis and obesity among nondialysis-dependent and kidney transplant patients. The agreement was poor between muscle mass and strength criteria; substantial between FMI, BMI, and %FM and fair between WC and the other measures; for sarcopenic obesity, it varied from poor to almost perfect. CONCLUSION Significant differences were found among the various diagnostic criteria that are used in the diagnosis of sarcopenic obesity. Our results highlight the need for standardization in the diagnosis of sarcopenic obesity.
Collapse
Affiliation(s)
- Natália Tomborelli Bellafronte
- Post-graduate Program in Health Sciences, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto City, Brazil
- *Natália Tomborelli Bellafronte,
| | - Amanda de Queirós Mattoso Ono
- Nutrition and Metabolism Undergraduate Course, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto City, Brazil
| | - Paula Garcia Chiarello
- Department of Health Sciences, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto City, Brazil
| |
Collapse
|
6
|
van Rijn MHC, van de Luijtgaarden M, van Zuilen AD, Blankestijn PJ, Wetzels JFM, Debray TPA, van den Brand JAJG. Prognostic models for chronic kidney disease: a systematic review and external validation. Nephrol Dial Transplant 2020; 36:1837-1850. [PMID: 33051669 DOI: 10.1093/ndt/gfaa155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Accurate risk prediction is needed in order to provide personalized healthcare for chronic kidney disease (CKD) patients. An overload of prognosis studies is being published, ranging from individual biomarker studies to full prediction studies. We aim to systematically appraise published prognosis studies investigating multiple biomarkers and their role in risk predictions. Our primary objective was to investigate if the prognostic models that are reported in the literature were of sufficient quality and to externally validate them. METHODS We undertook a systematic review and appraised the quality of studies reporting multivariable prognosis models for end-stage renal disease (ESRD), cardiovascular (CV) events and mortality in CKD patients. We subsequently externally validated these models in a randomized trial that included patients from a broad CKD population. RESULTS We identified 91 papers describing 36 multivariable models for prognosis of ESRD, 50 for CV events, 46 for mortality and 17 for a composite outcome. Most studies were deemed of moderate quality. Moreover, they often adopted different definitions for the primary outcome and rarely reported full model equations (21% of the included studies). External validation was performed in the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners trial (n = 788, with 160 events for ESRD, 79 for CV and 102 for mortality). The 24 models that reported full model equations showed a great variability in their performance, although calibration remained fairly adequate for most models, except when predicting mortality (calibration slope >1.5). CONCLUSIONS This review shows that there is an abundance of multivariable prognosis models for the CKD population. Most studies were considered of moderate quality, and they were reported and analysed in such a manner that their results cannot directly be used in follow-up research or in clinical practice.
Collapse
Affiliation(s)
- Marieke H C van Rijn
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Moniek van de Luijtgaarden
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jack F M Wetzels
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan A J G van den Brand
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Epicardial adipose tissue in patients with chronic kidney disease: a meta-analysis study and trial sequential analysis. Int Urol Nephrol 2020; 52:2345-2355. [PMID: 32720030 DOI: 10.1007/s11255-020-02575-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death in patients with chronic kidney disease (CKD). Epicardial adipose tissue (EAT) is an independent predictor of cardiovascular disease in the general population, and usually increases in the patients with cardiovascular disease risk. The change of EAT in patients with CKD was still controversial. For further understanding, we conducted a meta-analysis of the relevant literature. METHODS Eligible studies were searched in PubMed, EMBASE, Web of Science, and Scopus on March 13, 2020. The summarized standard mean difference (SMD) with 95% confidence intervals (CIs) were used to assess the association between EAT (thickness and volume) and CKD. Trial sequential analysis was conducted to estimate whether the evidence of the results is sufficient. RESULTS In total, 17 studies with 1961 participants (1205 patients in the CKD group and 756 participants in the control group) were involved. The EAT thickness was significantly increased in the CKD group compared to the control group (SMD = 1.31, 95% CI 0.89-1.73, P < 0.001) in eleven studies. The EAT volume was significantly increased in the CKD group compared to the control group (SMD = 0.77, 95% CI 0.63-0.91, P < 0.001) in six studies. Trial sequential analysis indicated that the available samples were sufficient and confirmed that firm evidence was reached. CONCLUSIONS Patients with CKD have higher EAT thickness and volume compared to control subjects without CKD.
Collapse
|
8
|
Sagittal abdominal diameter and Framingham risk score in non-dialysis chronic kidney disease patients. Int Urol Nephrol 2018; 50:1679-1685. [PMID: 29651697 DOI: 10.1007/s11255-018-1861-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that abdominal obesity is a risk factor for cardiovascular mortality. We investigated the link between sagittal abdominal diameter (SAD) and Framingham risk score in non-dialysis CKD patients. METHODS In a cross-sectional study, we enrolled 307 prevalent non-dialysis CKD patients (175 males, aged 50.7 ± 17.04 years). SAD and Framingham risk score were measured. RESULTS Framingham cardiovascular disease risk score was independently predicted by SAD (P < 0.01), GFR (P < 0.01) and diabetic history (P < 0.05). Adjusted R2 of the model was 0.178. SAD could be independently predicted by BMI (P < 0.01), diabetic history (P < 0.01), GFR (P < 0.01) and age (P < 0.01). Adjusted R2 of the model was 0.409. Using receiver operating characteristic (ROC) curve, a cutoff SAD value of 16.55 cm was determined with sensitivity of 63.7%, specificity of 58.3%. CONCLUSION Elevated SAD is significantly associated with increased Framingham risk score in non-dialysis CKD patients. SAD can be predicted by patients' BMI, diabetic history, renal function and age. Further investigation is needed to explore the potential benefits of central obesity lowering therapy in this patient group.
Collapse
|
9
|
Lin TY, Lim PS, Hung SC. Normal-weight obesity and clinical outcomes in nondiabetic chronic kidney disease patients: a cohort study. Am J Clin Nutr 2018; 107:664-672. [PMID: 29635500 DOI: 10.1093/ajcn/nqy006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background Normal-weight obesity (NWO), defined by a normal body mass index (BMI) and high body fat percentage, has been shown to be associated with cardiometabolic dysfunction and an increased risk of cardiovascular disease and mortality in the general population. However, little is known about the clinical implications of NWO among patients with chronic kidney disease (CKD). Objective The aim of this study was to assess the characteristics and outcomes of nondiabetic CKD patients with NWO. Design A total of 178 nondiabetic patients with stages 3-5 CKD were prospectively followed for a median of 4.9 y. The patients were classified into 3 different adiposity phenotypes: nonobese [BMI (in kg/m2) <25 and fat mass percentage (FM%) ≤25% for men or ≤35% for women], NWO (BMI <25 and FM% >25% for men or >35% for women), and preobese-obese (BMI ≥25). FM% was determined using the Body Composition Monitor, a multifrequency bioimpedance spectroscopy device. The outcome was a composite of cardiovascular events or all-cause mortality. Results The prevalence of NWO was 28.1% among nondiabetic CKD patients with a normal BMI. NWO patients were older, had lower lean body mass, and had higher plasma interleukin-6 concentrations than nonobese patients. However, homeostatic model assessment for insulin resistance levels did not differ between the 2 groups. NWO patients showed a significant 3-fold higher risk of the composite outcome (HR 2.96, 95% CI: 1.13, 7.77; P < 0.05) than did nonobese patients in the fully adjusted model. Preobese-obese patients were not at increased risk compared to nonobese patients. Conclusions NWO was associated with the worst prognosis among the 3 different adiposity phenotypes in nondiabetic CKD patients. Our findings suggest the importance of using direct measures of adiposity for risk assessment in CKD patients who are normal-weight. This trial was registered at clinicaltrials.gov as NCT03285074.
Collapse
Affiliation(s)
- Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Paik-Seong Lim
- Division of Renal Medicine, Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.,Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Rehabilitation, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
10
|
Waist circumference as a predictor of mortality in peritoneal dialysis patients: a follow-up study of 48 months. Br J Nutr 2017; 117:1299-1303. [PMID: 28583215 DOI: 10.1017/s0007114517001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Body-fat gain is a common finding among peritoneal dialysis (PD) patients, and the accumulation of adipose tissue occurs predominantly in the abdominal area. Waist circumference (WC) is a reliable marker of abdominal obesity and its association with worse outcomes has been demonstrated in non-dialysis and haemodialysis patients. We aimed at investigating whether WC measurements as well as the changes over time in WC were able to predict mortality in PD patients. This prospective study included 109 patients undergoing PD (57 % male, age 52 (sd 16) years, 32 % diabetics, 48 % BMI≥25 kg/m2). WC was measured at the umbilicus level (empty abdominal cavity), and values >88 cm for women and >102 cm for men were considered high. Nutritional status and laboratory parameters were also evaluated. WC was measured at baseline and after 6 months, and mortality was registered during a period of 48 months. High WC was observed in 55 % of women and in 23 % of men at baseline. After 6 months, 61 % of the patients showed an increased WC. At the end of the study, twenty-seven deaths were registered. A significant increase in WC was observed only in the non-survivor group. In the Cox regression analysis adjusting for sex, age, duration on dialysis, diabetes, BMI, serum albumin and C-reactive protein, high WC at baseline as well as the 6-month increase in WC were independently associated with mortality. This study demonstrated that a high WC and the increase over time in WC were both predictors of mortality in PD patients.
Collapse
|
11
|
Zha Y, Qian Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients 2017; 9:nu9030208. [PMID: 28264439 PMCID: PMC5372871 DOI: 10.3390/nu9030208] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/23/2017] [Indexed: 01/28/2023] Open
Abstract
Elevated protein catabolism and protein malnutrition are common in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The underlying etiology includes, but is not limited to, metabolic acidosis intestinal dysbiosis; systemic inflammation with activation of complements, endothelin-1 and renin-angiotensin-aldosterone (RAAS) axis; anabolic hormone resistance; energy expenditure elevation; and uremic toxin accumulation. All of these derangements can further worsen kidney function, leading to poor patient outcomes. Many of these CKD-related derangements can be prevented and substantially reversed, representing an area of great potential to improve CKD and ESRD care. This review integrates known information and recent advances in the area of protein nutrition and malnutrition in CKD and ESRD. Management recommendations are summarized. Thorough understanding the pathogenesis and etiology of protein malnutrition in CKD and ESRD patients will undoubtedly facilitate the design and development of more effective strategies to optimize protein nutrition and improve outcomes.
Collapse
Affiliation(s)
- Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guizhou 550002, China.
| | - Qi Qian
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
12
|
Kunimura A, Ishii H, Uetani T, Harada K, Hirayama K, Harata S, Shibata Y, Kawashima K, Shimbo Y, Takayama Y, Tatami Y, Kawamiya T, Osugi N, Ota T, Yamamoto D, Okumura N, Suzuki S, Amano T, Murohara T. Impact of adipose tissue composition on cardiovascular risk assessment in patients with stable coronary artery disease. Atherosclerosis 2016; 251:206-212. [PMID: 27372206 DOI: 10.1016/j.atherosclerosis.2016.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Visceral adipose tissue (VAT), unlike subcutaneous adipose tissue (SAT), is highly correlated with cardiovascular risk factors. This study aimed to evaluate the predictive value of adipose tissue composition, as measured by computed tomography, for cardiovascular events in patients with stable coronary artery disease. METHODS 357 consecutive patients who underwent 64-slice computed tomography and elective percutaneous coronary intervention (PCI) were recruited. The ratio of visceral to subcutaneous adipose tissue (VAT/SAT) was calculated. Patients were divided into three groups in accordance with VAT/SAT (low VAT/SAT, <0.55 [<25th percentile]; moderate VAT/SAT, 0.55-1.03 [25th-75th percentile]; high VAT/SAT, ≥1.03 [≥75th percentile]). The investigated risk factors were hypertension, hyperglycaemia, and dyslipidaemia. We analysed the incidence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction, and any revascularization. RESULTS The rate of patients with two or more concomitant risk factors was significantly higher in the high VAT/SAT group (p = 0.006). During 1480 person-years, 109 events were documented. There was a significant association between the incidence of MACE and VAT/SAT, with the worst event-free survival rate in the high VAT/SAT group (log-rank, p = 0.01). In Cox analysis, the hazard ratio of high VAT/SAT for MACE was 2.72 (95% confidence interval 1.04-7.09, p = 0.04) compared with the low VAT/SAT after adjustment for confounding factors. CONCLUSIONS Increased VAT/SAT is independently associated with the incidence of MACE, indicating that adipose tissue composition is a useful predictor of cardiovascular outcome, after elective PCI.
Collapse
Affiliation(s)
- Ayako Kunimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadayuki Uetani
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Harata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yohei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Kawashima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusaku Shimbo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yohei Takayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiki Kawamiya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naohiro Osugi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoyuki Ota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Yamamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi-Medical University, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW To summarize the latest information on body composition among patients with chronic kidney disease and its association with outcomes. RECENT FINDINGS Obesity is increasing among patients with end-stage renal disease and is more prevalent when direct measures of adiposity are used rather than BMI. High BMI is not associated with better survival among patients with earlier chronic kidney disease or after kidney transplantation, suggesting that excess fat is most protective among the sickest patients. Despite the positive association between BMI and survival among patients with end-stage renal disease, visceral fat is associated with coronary artery calcification and adverse cardiovascular events. Muscle wasting is prominent among patients with chronic kidney disease, sometimes even in the setting of obesity. Obesity and muscle wasting are associated with worse physical functioning. Indicators of low muscle size and strength are associated with higher mortality. Some interventions can affect body composition, but whether they affect survival has not been determined. SUMMARY Recent studies show that a high BMI is not protective for all patients with chronic kidney disease and is associated with poor physical functioning and frailty. Visceral adiposity is associated with adverse cardiovascular outcomes. Sarcopenia is common among patients with end-stage renal disease and is associated with worse physical performance and higher mortality.
Collapse
|
14
|
High BMI among adult haemodialysis patients at a UK hospital: an indicator of poor or adequate nutritional status? Proc Nutr Soc 2016. [DOI: 10.1017/s0029665115004425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
15
|
Cordeiro AC, Amparo FC, Oliveira MAC, Amodeo C, Smanio P, Pinto IMF, Lindholm B, Stenvinkel P, Carrero JJ. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease. J Intern Med 2015; 278:77-87. [PMID: 25556720 DOI: 10.1111/joim.12344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been hypothesized that epicardial adipose tissue (EAT) exerts pathogenic effects on cardiac structures. We analysed the associations between EAT and both cardiovascular (CV) disease risk factors and CV events in patients with chronic kidney disease (CKD). PATIENTS AND METHODS We included 277 nondialysed patients [median age 61, interquartile range (IQR) 53-68 years; 63% men] with stages 3-5 CKD in this cross-sectional evaluation. EAT and abdominal visceral adipose tissue (VAT) were assessed by computed tomography. Patients were followed for median 32 (IQR 20-39) months, and the composite of fatal and nonfatal CV events was recorded. RESULTS With increasing EAT quartiles, patients were older, had higher glomerular filtration rate, body mass index, waist, VAT and coronary calcification, higher levels of haemoglobin, triglycerides, albumin, C-reactive protein and leptin and higher prevalence of left ventricular hypertrophy and myocardial ischaemia; total and high-density lipoprotein cholesterol, 25-hydroxy-vitamin D and 1, 25-dihydroxy-vitamin D progressively decreased. Associations between EAT and cardiac alterations were not independent of VAT. During follow-up, 58 CV events occurred. A 1-SD higher EAT volume was associated with an increased risk of CV events in crude [hazard ratio (HR) 1.41, 95% confidence interval (CI) (1.12-1.78) and adjusted (HR 1.55, 95% CI 1.21-1.99) Cox models. However, adding EAT to a standard CV disease risk prediction model did not result in a clinically relevant improvement in prediction. CONCLUSION Epicardial adipose tissue accumulation in patients with CKD increases the risk of CV events independent of general adiposity. This is consistent with the notion of a local pathogenic effect of EAT on the heart or heart vessels, or both. However, EAT adds negligible explanatory power to standard CV disease risk factors.
Collapse
Affiliation(s)
- A C Cordeiro
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - F C Amparo
- Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - M A C Oliveira
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - C Amodeo
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - P Smanio
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - I M F Pinto
- Department of Radiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - B Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - P Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J J Carrero
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Ryckman EM, Summers RM, Liu J, del Rio AM, Pickhardt PJ. Visceral fat quantification in asymptomatic adults using abdominal CT: is it predictive of future cardiac events? ABDOMINAL IMAGING 2015; 40:222-6. [PMID: 25015400 PMCID: PMC4293368 DOI: 10.1007/s00261-014-0192-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to determine if quantifying visceral adipose tissue (VAT) at CT in asymptomatic adults can predict the likelihood of future cardiac events. METHODS Subcutaneous and visceral fat volumes were obtained from abdominal CT utilizing a validated semi-automated software tool in 663 asymptomatic adults (mean age 57.3 years, 379F/284M) undergoing colorectal screening. Patients were followed for subsequent cardiac events, defined as myocardial infarction or coronary intervention for a mean follow-up interval of 7.0 ± 1.4 years. Relevant clinical data including Framingham risk score (FRS) were also collected. Statistical analysis included logistic regression, Pearson correlation coefficients, and Welch and Wilcoxon rank sum tests. RESULTS Cardiac events were documented in 32 subjects (4.8%) an average 3.0 years after index CT. FRS was predictive of future cardiac events, signified by a higher score (mean score 11.9 vs. 7.4; p < 0.001). HDL levels were significantly lower in the cardiac event cohort (mean 52.2 vs. 61.0; p < 0.01). None of the other clinical variables were predictive and none of the CT-based fat measurements (visceral, subcutaneous, and total adipose tissue; visceral fat %) correlated with future cardiac events (p = 0.561–0.886). Mean visceral fat % in the cardiac event cohort was 38.1% vs. 39.1% for the non-event group. CONCLUSION Quantification of VAT at abdominal CT was not predictive of future cardiac events in this asymptomatic cohort, whereas HDL levels and FRSs correlated well with risk.
Collapse
Affiliation(s)
- Eva M. Ryckman
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA, 53792-3252
| | - Ronald M. Summers
- Imaging Biomarkers and Computer-aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center Bethesda, MD, USA, 20892-1182
| | - Jiamin Liu
- Imaging Biomarkers and Computer-aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center Bethesda, MD, USA, 20892-1182
| | - A Munoz del Rio
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA, 53792-3252
| | - Perry J. Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA, 53792-3252
| |
Collapse
|
17
|
Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease. Int Urol Nephrol 2014; 47:359-67. [DOI: 10.1007/s11255-014-0894-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
|
18
|
Carrero JJ, Avesani CM. Pros and Cons of Body Mass Index as a Nutritional and Risk Assessment Tool in Dialysis Patients. Semin Dial 2014; 28:48-58. [DOI: 10.1111/sdi.12287] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Juan Jesús Carrero
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Center for Molecular Medicine; Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
| | - Carla Maria Avesani
- Department of Applied Nutrition; Nutrition Institute; Rio de Janeiro State University; Rio de Janeiro Brazil
| |
Collapse
|
19
|
Gonzalez-Campoy JM, Richardson B, Richardson C, Gonzalez-Cameron D, Ebrahim A, Strobel P, Martinez T, Blaha B, Ransom M, Quinonez-Weislow J, Pierson A, Gonzalez Ahumada M. Bariatric endocrinology: principles of medical practice. Int J Endocrinol 2014; 2014:917813. [PMID: 24899894 PMCID: PMC4036612 DOI: 10.1155/2014/917813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/19/2014] [Accepted: 04/11/2014] [Indexed: 12/11/2022] Open
Abstract
Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology-the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements.
Collapse
Affiliation(s)
- J. Michael Gonzalez-Campoy
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Bruce Richardson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Conor Richardson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - David Gonzalez-Cameron
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Ayesha Ebrahim
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Pamela Strobel
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Tiphani Martinez
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Beth Blaha
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Maria Ransom
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Jessica Quinonez-Weislow
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Andrea Pierson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Miguel Gonzalez Ahumada
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| |
Collapse
|
20
|
Okamoto T, Morimoto S, Ikenoue T, Furumatsu Y, Ichihara A. Visceral fat level is an independent risk factor for cardiovascular mortality in hemodialysis patients. Am J Nephrol 2014; 39:122-9. [PMID: 24503580 DOI: 10.1159/000358335] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/27/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Obesity is an independent risk factor for morbidity and mortality in cardiovascular diseases not only in the general population, but also in hemodialysis (HD) patients. We previously reported that an increased visceral fat area (VFA) determined using computed tomography (CT) scans was associated with atherosclerosis in HD patients. However, whether a high VFA is associated with increased cardiovascular mortality in HD patients remains unknown. Therefore, we investigated the relationship between VFA and prognosis in HD patients. METHODS VFA was estimated in 126 patients on maintenance HD using CT scans. These patients were followed for 60 months. RESULTS Kaplan-Meier analysis revealed that the cardiovascular survival rate was significantly lower in the high-VFA group, with a VFA of 71.5 cm(2) or greater, than in the low-VFA group, with a VFA of less than 71.5cm(2). In univariate Cox proportional hazards analyses, age, albumin, low-density lipoprotein cholesterol, cardio-thoracic ratio and VFA above 71.5 cm(2) were significantly correlated with cardiovascular deaths. In multivariate analyses testing these factors as dependent variables, VFA above 71.5 cm(2) was estimated to be an independent predictor of cardiovascular deaths. CONCLUSION These results suggest that an increased VFA is a stronger risk factor for cardiovascular deaths in HD patients. Measuring VFA may be recommended for predicting the risk of cardiovascular diseases in HD patients.
Collapse
Affiliation(s)
- Takayuki Okamoto
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | |
Collapse
|
21
|
Baria F, Kamimura MA, Aoike DT, Ammirati A, Leister Rocha M, de Mello MT, Cuppari L. Randomized controlled trial to evaluate the impact of aerobic exercise on visceral fat in overweight chronic kidney disease patients. Nephrol Dial Transplant 2014; 29:857-64. [DOI: 10.1093/ndt/gft529] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
22
|
Cronin O, Bradshaw B, Iyer V, Cunningham M, Buttner P, Walker PJ, Golledge J. The association of visceral adiposity with cardiovascular events in patients with peripheral artery disease. PLoS One 2013; 8:e82350. [PMID: 24386093 PMCID: PMC3873921 DOI: 10.1371/journal.pone.0082350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/29/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have suggested that patients with peripheral artery disease (PAD) suffer from a high incidence of cardiovascular events (CVE). Visceral adiposity has been implicated in promoting CVEs. This study aimed to assess the association of relative visceral adipose volume with incident cardiovascular events in patients with peripheral artery disease. METHODS This was a prospective cohort study including 260 patients with PAD who presented between 2003 and 2012. Cases were patients with diagnosed PAD including symptomatic lower limb athero-thrombosis and asymptomatic abdominal aortic aneurysm. All patients underwent computed tomography angiography (CTA). Abdominal visceral to total adipose volume ratio (relative visceral adipose volume) was estimated from CTAs using a previously validated workstation protocol. Cardiovascular risk factors were recorded at entry. The association of visceral adiposity with major CVEs (death, non-fatal myocardial infarction or stroke) was examined using Kaplan Meier and Cox proportional hazard analyses. RESULTS A total of 92 major CVEs were recorded in 76 patients during a median follow-up of 2.8 (IQR 1.2 to 4.8) years, including myocardial infarction (n = 26), stroke (n = 10) and death (n = 56). At 3 years the incidence of major CVEs stratified by relative visceral adipose volume quartiles were 15% [Quartile (Q) 1], 17% (Q2), 11% (Q3) and 15% (Q4) (P = 0.517). Relative visceral adipose volume was not associated with major CVEs after adjustment for other risk factors. CONCLUSION This study suggests that visceral adiposity does not play a central role in the predisposition for major CVEs in patients with PAD.
Collapse
Affiliation(s)
- Oliver Cronin
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Barbara Bradshaw
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Vikram Iyer
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Cunningham
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Petra Buttner
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
| | - Philip J. Walker
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| |
Collapse
|
23
|
Beddhu S, Abraham J. Risk factor paradox in CKD and ESRD: does a healthy lifestyle matter? Clin J Am Soc Nephrol 2013; 8:515-7. [PMID: 23520045 DOI: 10.2215/cjn.02030213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
24
|
Hughes-Austin JM, Larsen BA, Allison MA. Visceral Adipose Tissue and Cardiovascular Disease Risk. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0298-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|