Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
Nephrol Dial Transplant. 2013 Nov;28 Suppl 4:iv152-9. doi: 10.1093/ndt/gft250. Epub 2013 Jul 5.
Abdominal fat is a metabolically active tissue which has been associated with cardiovascular events and death in chronic kidney disease (CKD) patients. We explore here the association between surrogates of abdominal fat and coronary artery calcium score (CACs).
Cross-sectional analysis of 232 non-dialysis-dependent CKD patients Stages 3-5 (median age 60 [25th-75th percentile 52-67] years; 60% men). Visceral adipose tissue (VAT) and CACs were assessed by computed tomography. Surrogates of abdominal fat included VAT and waist circumference (WC).
VAT was positively associated with CACs in univariate analysis (ρ = 0.23). Across increasing VAT quartiles, patients were older, more often men and smokers. Although increasing VAT quartiles associated with higher glomerular filtration rate and leptin, better nutritional status (subjective global assessment) as well as larger muscle stores and strength, they were also more insulin resistant (HOMA-IR), dyslipidemic and inflamed (C-reactive protein and white blood cells). In addition, CACs were incrementally higher. Clinically evident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat (odd ratio 1.60 [95% CI 1.23-2.09] per standard deviation increase) and increased WC (1.05 [1.01-1.12] per cm increase), augmented the odds to present calcification. Such associations remained statistically significant after extensive multivariate adjustment for confounders.
Abdominal fat is associated with coronary artery calcification in non-dialysis dependent CKD patients, supporting its potential role as a cardiovascular risk factor in uremia.
腹部脂肪是一种代谢活跃的组织，与慢性肾脏病（CKD）患者的心血管事件和死亡有关。我们在此探讨腹部脂肪替代物与冠状动脉钙评分（CACs）之间的关系。
对 232 名非透析依赖性 CKD 患者（3-5 期，中位年龄 60 [25-75 百分位数 52-67] 岁；60%为男性）进行横断面分析。通过计算机断层扫描评估内脏脂肪组织（VAT）和 CACs。腹部脂肪的替代物包括 VAT 和腰围（WC）。
在单变量分析中，VAT 与 CACs 呈正相关（ρ=0.23）。随着 VAT 四分位数的增加，患者年龄更大，男性和吸烟者更多。尽管随着 VAT 四分位数的增加，肾小球滤过率和瘦素升高，营养状况（主观整体评估）以及肌肉储存和力量增加，但胰岛素抵抗（HOMA-IR）、血脂异常和炎症（C-反应蛋白和白细胞）也更为严重。此外，CACs 逐渐升高。63%的患者存在临床明显的冠状动脉钙化（CACs≥10 个 Agatston）。内脏脂肪增加（每标准差增加 1.60 [95%CI 1.23-2.09]）和 WC 增加（每增加 1cm 增加 1.05 [1.01-1.12]）均增加了出现钙化的几率。在对混杂因素进行广泛的多变量调整后，这些关联仍然具有统计学意义。
在非透析依赖性 CKD 患者中，腹部脂肪与冠状动脉钙化相关，支持其作为尿毒症患者心血管风险因素的潜在作用。
