Kono Teruyuki, Maimaituxun Gulinu, Tanabe Hayato, Higa Moritake, Saito Haruka, Tanaka Kenichi, Masuzaki Hiroaki, Sata Masataka, Kazama Junichiro J, Shimabukuro Michio
Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Tomishiro, Okinawa, Japan.
BMJ Open Diabetes Res Care. 2024 Mar 11;12(2):e003832. doi: 10.1136/bmjdrc-2023-003832.
It remains unclear whether increased perirenal fat (PRF) accumulation is equally related to renal involvement in patients with and without diabetes mellitus (DM). We evaluated the association between PRF volume (PRFV) and low glomerular filtration rate (GFR) and proteinuria in people with or without type 2 diabetes mellitus (T2DM).
We performed a cross-sectional analysis of 473 individuals without T2DM (non-DM, n=202) and with T2DM (DM, n=271). PRFV (cm), obtained from non-contrast CT, was indexed as PRF index (PRFV/body surface area, cm/m). Multivariate-adjusted models were used to determine the ORs of PRFV and PRFV index for detecting estimated GFR (eGFR) decrease of <60 mL/min/1.73 m proteinuria onset, or both.
Although body mass index (BMI), visceral fat area, and waist circumference were comparable between the non-DM and DM groups, kidney volume, PRFV, and PRFV index were higher in individuals with T2DM than in those without T2DM. In the multivariate analysis, after adjusting for age, sex, BMI, hypertension, smoking history, and visceral fat area ≥100 cm, the cut-off values of PRFV index were associated with an eGFR<60 in individuals with DM (OR 6.01, 95% CI 2.20 to 16.4, p<0.001) but not in those without DM.
PRFV is associated with low eGFR in patients with T2DM but not in those without T2DM. This suggests that PRF accumulation is more closely related to the onset and progression of diabetic kidney disease (DKD) than non-DKD. Clarifying the mechanisms through which PRF influences DKD development could pave the way for novel prevention and treatment strategies.
肾周脂肪（PRF）堆积增加与糖尿病（DM）患者和非糖尿病患者的肾脏受累之间是否同样相关仍不清楚。我们评估了2型糖尿病（T2DM）患者和非T2DM患者的PRF体积（PRFV）与低肾小球滤过率（GFR）及蛋白尿之间的关联。
我们对473名个体进行了横断面分析，其中无T2DM者（非DM，n = 202）和有T2DM者（DM，n = 271）。通过非增强CT获得的PRFV（cm）被标化为PRF指数（PRFV/体表面积，cm/m）。使用多变量调整模型来确定PRFV和PRF指数检测估计GFR（eGFR）降低至<60 mL/min/1.73 m²、蛋白尿发生或两者兼有的比值比（OR）。
尽管非DM组和DM组之间的体重指数（BMI）、内脏脂肪面积和腰围相当，但T2DM患者的肾脏体积、PRFV和PRF指数高于非T2DM患者。在多变量分析中，在调整年龄、性别、BMI、高血压、吸烟史和内脏脂肪面积≥100 cm²后，PRF指数的临界值与DM患者的eGFR<60相关（OR 6.01，95%CI 2.20至16.4，p<0.001），但与非DM患者无关。
PRFV与T2DM患者的低eGFR相关，但与非T2DM患者无关。这表明PRF堆积与糖尿病肾病（DKD）的发生和进展比与非DKD的关系更密切。阐明PRF影响DKD发展的机制可为新的预防和治疗策略铺平道路。
