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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients

George A Kaysen1, Peter Kotanko, Fansan Zhu

  • 1Renal Research Institute, New York, New York, USA. gakaysen@ucdavis.edu

Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation
|July 15, 2009
PubMed

Insights

In hemodialysis patients, visceral fat, not BMI, influences triglyceride levels and inflammation markers. Obesity

Area of Science:

  • Nephrology
  • Cardiovascular Disease
  • Metabolic Syndrome

Background:

  • Obesity paradoxically linked to lower mortality in hemodialysis (HD) patients, unlike the general population.
  • General population obesity correlates with inflammation and dyslipidemia, increasing cardiovascular (CV) risk.
  • Renal failure itself causes dyslipidemia and inflammation, potentially masking obesity's effects in HD patients.

Purpose of the Study:

  • To investigate the relationship between adipose tissue distribution (subcutaneous vs. visceral) and CV risk factors in HD patients.
  • To determine if body composition, rather than overall BMI, better predicts CV risk in this population.
  • To explore how obesity-related factors like inflammation and lipid profiles are affected by renal failure.

Main Methods:

  • Magnetic resonance imaging (MRI) used to quantify subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).
  • Assessed inflammatory markers (C-reactive protein, IL-6, etc.), lipid profiles (HDL, LDL, TGs), apolipoproteins (apo AI, apo B, etc.), and adipokines (leptin, adiponectin).
  • Analyzed data from 48 prevalent HD patients.

Main Results:

  • Visceral adipose tissue (VAT) positively correlated with total triglycerides (TGs) and specific apolipoproteins (apo CII, apo CIII).
  • Adiponectin inversely correlated with VAT, while leptin associated positively with subcutaneous adipose tissue (SAT).
  • Inflammatory markers showed weak associations with SAT (C-reactive protein, alpha1 acid glycoprotein) or strong associations with VAT (ceruloplasmin); LDL, HDL, and IL-6 did not correlate with body composition.

Conclusions:

  • Adipose tissue distribution, particularly VAT, is more relevant than BMI for metabolic alterations in HD patients.
  • The lack of correlation between traditional CV risk markers (LDL, HDL, IL-6) and body composition may explain the obesity paradox in HD.
  • Renal failure may obscure the typical adverse effects of obesity on cardiovascular health by altering lipid and inflammatory profiles.
Abstract

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