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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Body-fat indicators and kidney function decline in older post-myocardial infarction patients: The Alpha Omega Cohort
Kevin Esmeijer1,2, Johanna M Geleijnse3, Erik J Giltay4
11 Department of Nephrology, Leiden University Medical Center, The Netherlands.
Insights
Obesity and high waist circumference accelerate kidney function decline in older patients after myocardial infarction. This study highlights the importance of weight management for cardiovascular and kidney health in this population.
Area of Science:
- Cardiology
- Nephrology
- Obesity Medicine
Background:
- Obesity is a known risk factor for hypertension and diabetes, major contributors to end-stage renal disease.
- The impact of obesity on kidney function decline in stable post-myocardial infarction (MI) patients remains under-investigated.
- This study addresses the relationship between obesity and kidney function in a large cohort of older individuals post-MI.
Purpose of the Study:
- To investigate the association between obesity (defined by body mass index and waist circumference) and the rate of kidney function decline in older patients post-MI.
- To evaluate the impact of obesity on estimated glomerular filtration rate (eGFR) in patients receiving optimal pharmacotherapy.
Main Methods:
- Analysis of data from 2410 post-MI patients (aged 60-80 years) from the Alpha Omega Trial.
- Calculation of cystatin C-based estimated glomerular filtration rate (eGFRcysC) at baseline and after 41 months using the CKD-EPI equation.
- Linear regression models were used to assess the relationship between body mass index, waist circumference, and annual eGFRcysC decline.
Main Results:
- At baseline, 23% of patients were classified as obese (body mass index ≥ 30 kg/m²).
- After multivariable adjustment, a greater annual eGFRcysC decline was observed in obese patients and those with high waist circumference compared to their non-obese counterparts.
- An additional annual eGFRcysC decline was noted per increment in body mass index for both men and women.
Conclusions:
- Higher body mass index and waist circumference are associated with a more rapid decline in kidney function among older, stable post-MI patients.
- These findings underscore the importance of weight management in preserving kidney function in this patient group.
- The results emphasize the link between obesity and adverse renal outcomes even in patients receiving optimal medical treatment.
Abstract:
Background Obesity increases risk of hypertension and diabetes, the leading causes of end-stage renal disease. The effect of obesity on kidney function decline in stable post-myocardial infarction patients is poorly documented. This relation was investigated in a large cohort of older post-myocardial infarction patients. Design Data were analysed from 2410 post-myocardial infarction patients in the Alpha Omega Trial, aged 60-80 years receiving optimal pharmacotherapy treatment (79% men, 18% diabetes). Methods Cystatin C based estimated glomerular filtration rate (eGFRcysC) was calculated at baseline and after 41 months, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Obesity was defined as body mass index ≥ 30 kg/m2 and high waist circumference as ≥102 and ≥88 cm for men and women. The relation between body mass index, waist circumference and annual eGFRcysC decline was evaluated by linear regression. Results At baseline, mean (standard deviation) eGFRcysC was 81.5 (19.6) ml/min/1.73 m2, 23% of all patients were obese. After multivariable adjustment, the annual mean (95% confidence interval) eGFRcysC decline in men and women was -1.45 (-1.59 to -1.31) and -0.92 (-1.20 to -0.63) ml/min/1.73 m2, respectively ( p = 0.001). Obese versus non-obese patients and patients with high versus normal waist circumference experienced greater annual eGFRcysC decline. Men and women showed an additional annual eGFRcysC decline of -0.35 (-0.56 to -0.14) and -0.21 (-0.55 to 0.14) ml/min/1.73 m2 per 5 kg/m2 body mass index increment ( p for interaction 0.3). Conclusions High compared to normal body mass index or waist circumference were associated with more rapid kidney function decline in older stable post-myocardial infarction patients receiving optimal drug therapy.
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