Barbieri Diego, Goicoechea Marian, Sánchez-Niño Maria Dolores, Ortiz Alberto, Verde Eduardo, Verdalles Ursula, Pérez de José Ana, Delgado Andrés, Hurtado Esther, Sánchez-Cámara Luis, Lopez-Lazareno Nieves, García-Prieto Ana, Luño José
Department of Nephrology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Spanish Kidney Research Network (REDinREN), Madrid, Spain.
Clin Kidney J. 2018 Oct 11;12(3):420-426. doi: 10.1093/ckj/sfy095. eCollection 2019 Jun.
Obesity is a risk factor for incident chronic kidney disease (CKD) in the general population. C1q/tumour necrosis factor-related protein 1 (CTRP1) is a new adipokine with multiple vascular and metabolic effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP1 levels and CKD progression.
Patients with Stages 3 and 4 CKD without previous cardiovascular events were enrolled and divided into two groups according to body mass index (BMI). Demographic, clinical and analytical data and CTRP1 levels were collected at baseline. During follow-up, renal events [defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate (Modification of Diet in Renal Disease)] were registered.
A total of 71 patients with CKD were divided into two groups: 25 obese (BMI >30 kg/m) and 46 non-obese. CTRP1 in plasma at baseline was higher in obese patients [median (interquartile range) 360 (148) versus 288 (188) ng/mL, P = 0.041]. No significant association was found between CTRP1 levels and CKD stage, presence of diabetes, aldosterone and renin levels, or blood pressure. Obese patients had higher systolic blood pressure (P = 0.018) and higher high-sensitivity C-reactive protein (P = 0.019) and uric acid (P = 0.003) levels, without significant differences in the percentage of diabetic patients or albuminuria. During a mean follow-up of 65 months, 14 patients had a renal event. Patients with CTRP1 in the lowest tertile had more renal events, both in the overall sample (log rank: 5.810, P = 0.016) and among obese patients (log rank: 5.405, P = 0.020). Higher CTRP1 levels were associated with slower renal progression (hazard ratio 0.992, 95% confidence interval 0.986-0.998; P = 0.001) in a model adjusted for obesity, aspirin, albuminuria and renal function.
CTRP1 levels are higher in obese than in non-obese patients with CKD. High CTRP1 levels may have a renal protective role since they were associated with slower kidney disease progression. Interventional studies are needed to explore this hypothesis.
肥胖是普通人群中慢性肾脏病（CKD）发病的危险因素。C1q/肿瘤坏死因子相关蛋白1（CTRP1）是一种具有多种血管和代谢作用的新型脂肪因子，可能调节肥胖与血管疾病之间的关联。本研究旨在探讨肥胖、CTRP1水平与CKD进展之间的潜在联系。
纳入无既往心血管事件的3期和4期CKD患者，并根据体重指数（BMI）分为两组。在基线时收集人口统计学、临床和分析数据以及CTRP1水平。在随访期间，记录肾脏事件[定义为开始透析、血清肌酐翻倍或估计肾小球滤过率降低50%（肾脏病饮食改良法）]。
共有71例CKD患者分为两组：25例肥胖患者（BMI>30kg/m）和46例非肥胖患者。肥胖患者基线时血浆CTRP1水平较高[中位数（四分位间距）360（148）对288（188）ng/mL，P=0.041]。未发现CTRP1水平与CKD分期、糖尿病、醛固酮和肾素水平或血压之间存在显著关联。肥胖患者的收缩压较高（P=0.018），高敏C反应蛋白（P=0.019）和尿酸（P=0.003）水平较高，糖尿病患者百分比或蛋白尿无显著差异。在平均65个月的随访期间，14例患者发生了肾脏事件。CTRP1处于最低三分位数的患者发生肾脏事件的更多，在总体样本中（对数秩检验：5.810，P=0.016）以及肥胖患者中（对数秩检验：5.405，P=0.020）均如此。在调整了肥胖、阿司匹林、蛋白尿和肾功能的模型中，较高的CTRP1水平与较慢的肾脏进展相关（风险比0.992，95%置信区间为0.986-0.998；P=0.001）。
肥胖的CKD患者CTRP1水平高于非肥胖患者。较高的CTRP1水平可能具有肾脏保护作用，因为它们与较慢的肾脏疾病进展相关。需要进行干预性研究来探索这一假设。
