Norman Glenda, Woodiwiss Angela J, Peterson Vernice, Gomes Monica, Sareli Pinhas, Norton Gavin R
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Email:
Cardiovasc J Afr. 2020 Mar/Apr;31(4):91-102. doi: 10.5830/CVJA-2019-057. Epub 2020 Mar 11.
To determine the extent to which metabolic and inflammatory changes are associated with renal damage beyond conventional risk factors in a community sample with a high prevalence of obesity in urban South Africa.
This was a cross-sectional, community-based study in 1 010 ( = 872 without diabetes mellitus, DM) randomly selected participants over 16 years of age in an urban, developing community (Soweto, Johannesburg) with a high prevalence of obesity (41.8%). We assessed estimated glomerular filtration rate (eGFR), conventional risk factors including adiposity indices, and metabolic changes and plasma resistin concentrations (ELISA) and the homeostasis model of insulin resistance (HOMA-IR). Relationships independent of haemodynamic loads were confirmed using ambulatory blood pressure and central arterial haemodynamics.
In multivariate regression models conducted in those without DM, HOMA-IR (standardised -coefficient = -0.13 ± 0.03, < 0.0001) and plasma resistin concentrations (-coefficient = -0.10 ± 0.02, < 0.0001) were second only to age, and at least as strong as systolic blood pressure ( -coefficient = -0.04 ± 0.03, = 0.19) in the impact on eGFR, while alternative conventional risk factors including adiposity indices and the metabolic syndrome features contributed little to eGFR. Similar results were obtained in relationships with chronic kidney disease (CKD) and in the whole group including those with DM. Adjustments for ambulatory blood pressure or central arterial loads did not influence these relationships.
The impact on glomerular function of insulin resistance and inflammatory changes is well beyond modifiable conventional risk factors, including the metabolic syndrome. Targeting conventional risk factors alone is likely to result in a marked residual risk of renal damage produced by insulin resistance and inflammation.
在南非城市肥胖患病率较高的社区样本中，确定代谢和炎症变化与超出传统危险因素的肾损害之间的关联程度。
这是一项基于社区的横断面研究，在约翰内斯堡索韦托这个肥胖患病率较高（41.8%）的城市发展中社区，随机选取了1010名16岁以上的参与者（n = 872无糖尿病）。我们评估了估计肾小球滤过率（eGFR）、包括肥胖指数在内的传统危险因素、代谢变化、血浆抵抗素浓度（酶联免疫吸附测定）以及胰岛素抵抗稳态模型（HOMA-IR）。使用动态血压和中心动脉血流动力学来确认独立于血流动力学负荷的关系。
在无糖尿病患者中进行的多变量回归模型中，HOMA-IR（标准化β系数 = -0.13±0.03，P < 0.0001）和血浆抵抗素浓度（β系数 = -0.10±0.02，P < 0.0001）对eGFR的影响仅次于年龄，且至少与收缩压（β系数 = -0.04±0.03，P = 0.19）一样强，而包括肥胖指数和代谢综合征特征在内的其他传统危险因素对eGFR的贡献很小。在与慢性肾脏病（CKD）的关系以及包括糖尿病患者在内的整个组中也获得了类似结果。对动态血压或中心动脉负荷进行调整并未影响这些关系。
胰岛素抵抗和炎症变化对肾小球功能的影响远远超过可改变的传统危险因素，包括代谢综合征。仅针对传统危险因素可能会导致胰岛素抵抗和炎症引起的肾损害存在显著的残余风险。
