Unit of Endocrinology and Metabolic Diseases, Department of Medical Sciences and 2Unit of Nephrology, University of Foggia, Italy.
Nephrol Dial Transplant. 2011 Mar;26(3):892-8. doi: 10.1093/ndt/gfq522. Epub 2010 Aug 26.
Many interfering factors may reduce the reliability of waist circumference (WC) measurement in estimating the risk for chronic kidney disease (CKD) associated with obesity. Therefore, we determined the independent associations of para- and perirenal ultrasonographic fat thickness with the main markers of kidney function.
A cross-sectional study was performed in 151 type-2 diabetic subjects. Para- and perirenal fat thickness was measured from the inner side of the abdominal musculature to the surface of the kidneys. CKD was defined as eGFR < 60 mL min(-1)1.73 m(-2).
Using both univariate and multivariate regression analyses, eGFR, renal resistance index and uricaemia were best predicted by para- and perirenal fat thickness even when BMI and waist circumference were further added in the statistical model (r(2): 0.366, P = 0.001; r(2): 0.529, P = 0.005; r(2): 0.310, P = 0.026, respectively), whereas waist circumference and BMI did not contribute independently of para- and perirenal fat thickness. Albuminuria was predicted by waist circumference but not by para- and perirenal fat thickness. In subjects with waist circumference above the diagnostic values of metabolic syndrome (48M/59F), eGFR significantly and progressively declined across tertiles of para- and perirenal fat thickness (87.0 ± 27.9 vs 83.5 ± 26.0 vs 62.3 ± 30.6 mL min(-1) 1.73 m(-2), adjusted P < 0.0001) despite comparable waist circumference, and an increasing frequency of CKD was observed across tertiles of subjects with waist circumference both below and above the metabolic syndrome diagnostic values (P < 0.05).
Para- and perirenal fat thickness is an independent predictor of kidney dysfunction in type-2 diabetes explaining an important proportion of the variance of eGFR, renal resistance index and uricaemia.
许多干扰因素可能会降低腰围（WC）测量在估计肥胖相关慢性肾脏病（CKD）风险方面的可靠性。因此，我们确定了肾周和肾周超声脂肪厚度与肾功能主要标志物的独立关联。
在 151 例 2 型糖尿病患者中进行了横断面研究。从腹部肌肉的内侧到肾脏表面测量肾周和肾周脂肪厚度。CKD 的定义为 eGFR<60 mL min(-1)1.73 m(-2)。
使用单变量和多变量回归分析，即使在统计模型中进一步加入 BMI 和腰围时，eGFR、肾阻力指数和血尿酸也最好由肾周和肾周脂肪厚度预测（r(2)：0.366，P=0.001；r(2)：0.529，P=0.005；r(2)：0.310，P=0.026），而腰围和 BMI 不能独立于肾周和肾周脂肪厚度预测。白蛋白尿由腰围预测，但不由肾周和肾周脂肪厚度预测。在腰围高于代谢综合征诊断值（48M/59F）的患者中，eGFR 随着肾周和肾周脂肪厚度三分位的增加而显著逐渐下降（87.0±27.9 比 83.5±26.0 比 62.3±30.6 mL min(-1)1.73 m(-2)，调整后的 P<0.0001），尽管腰围相当，但在腰围低于和高于代谢综合征诊断值的患者中，CKD 的频率也随着三分位的增加而增加（P<0.05）。
肾周和肾周脂肪厚度是 2 型糖尿病患者肾功能障碍的独立预测因素，可解释 eGFR、肾阻力指数和血尿酸变异性的重要部分。
