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01.02.2012 | Original Article

Accumulation of visceral fat in maintenance hemodialysis patients

verfasst von: Takatomi Yurugi, Satoshi Morimoto, Takayuki Okamoto, Yoshifumi Amari, Yuko Kasuno, Masayoshi Fukui, Fumitaka Nakajima, Mitsushige Nishikawa, Toshiji Iwasaka

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 1/2012

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Abstract

Background

In hemodialysis (HD) patients, obesity has been recognized as a serious risk factor for mortality and morbidity for cardiovascular diseases. In addition, abnormalities of lipid profiles exist in these patients.

Methods

In patients undergoing maintenance HD, incidences of abnormality of lipid profiles and visceral obesity determined by computed tomography scans were compared. In addition, the relationship between visceral fat area (VFA) and brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, or carotid intima-media thickness (IMT), an index of atherosis, was examined.

Results

The incidence of high VFA (27.0%) was significantly greater than that of high body mass index (BMI) (9.7%), high low-density-lipoprotein cholesterol (LDL-C) (4.8%), and high triglyceride (12.7%). In patients with diabetes mellitus (DM), waist circumference and VFA showed a significant positive relationship with baPWV. baPWV was significantly higher in patients with high VFA and DM than in patients with low VFA without DM, those with high VFA without DM, and those with low VFA and DM. Carotid IMT was significantly greater in patients with high VFA and DM than in those with low VFA without DM and those with low VFA and DM.

Conclusions

The incidence of high VFA was much greater than that of high BMI, high LDL-C, or high triglyceride. Visceral fat accumulation may be related to both arterial stiffness and atherosis in diabetic patients on maintenance HD.

Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med. 1974;290(13):697–701.PubMedCrossRef

Levey AS, Beto JA, Coronado BE, Eknoyan G, Foley RN, Kasiske BL, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis. 1998;32(5):853–906.PubMedCrossRef

Iseki K. Role of chronic kidney disease in cardiovascular disease: are we different from others? Clin Exp Nephrol. 2011.

Salgueira M, del Toro N, Moreno-Alba R, Jimenez E, Areste N, Palma A. Vascular calcification in the uremic patient: a cardiovascular risk? Kidney Int Suppl. 2003;85:S119–21.

Barri YM. Hypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008;10(1):39–45.PubMedCrossRef

Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968–77.PubMedCrossRef

Kaizu Y, Tsunega Y, Yoneyama T, Sakao T, Hibi I, Miyaji K, et al. Overweight as another nutritional risk factor for the long-term survival of non-diabetic hemodialysis patients. Clin Nephrol. 1998;50(1):44–50.PubMed

Odamaki M, Furuya R, Ohkawa S, Yoneyama T, Nishikino M, Hishida A, et al. Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic haemodialysis patients. Nephrol Dial Transpl. 1999;14(10):2427–32.CrossRef

O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340(1):14–22.PubMedCrossRef

10.

Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96(5):1432–7.PubMed

11.

Kato A, Takita T, Maruyama Y, Kumagai H, Hishida A. Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients. Kidney Int. 2003;64(4):1472–9.PubMedCrossRef

12.

Inaba MOS, Kumeda Y, Yamada S, Imanishi Y, Tabata T, Okamura M, Okada S, Yamakawa T, Ishimura E, Nishizawa Y. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007;18:896–903.PubMedCrossRef

13.

Yamauchi T, Kuno T, Takada H, Nagura Y, Kanmatsuse K, Takahashi S. The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients. Nephrol Dial Transpl. 2003;18(9):1842–7.CrossRef

14.

O’Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens. 2002;15(5):426–44.PubMedCrossRef

15.

Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236–41.PubMed

16.

Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10–5.PubMedCrossRef

17.

Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085–90.PubMedCrossRef

18.

Imai E, Matsuo S, Makino H, Watanabe T, Akizawa T, Nitta K, et al. Chronic Kidney Disease Japan Cohort study: baseline characteristics and factors associated with causative diseases and renal function. Clin Exp Nephrol. 2010;14(6):558–70.PubMedCrossRef

19.

Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434–9.PubMed

20.

Blacher J, Safar ME, Pannier B, Guerin AP, Marchais SJ, London GM. Prognostic significance of arterial stiffness measurements in end-stage renal disease patients. Curr Opin Nephrol Hypertens. 2002;11(6):629–34.PubMedCrossRef

21.

Blacher J, Safar ME, Guerin AP, Pannier B, Marchais SJ, London GM. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int. 2003;63(5):1852–60.PubMedCrossRef

22.

Ghiadoni L, Taddei S, Virdis A, Sudano I, Di Legge V, Meola M, et al. Endothelial function and common carotid artery wall thickening in patients with essential hypertension. Hypertension. 1998;32(1):25–32.PubMed

23.

Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002;25(3):359–64.PubMedCrossRef

24.

Morimoto S, Nakajima F, Yurugi T, Morita T, Jo F, Nishikawa M, et al. Risk factors of normal ankle-brachial index and low toe-brachial index in hemodialysis patients. Ther Apher Dial. 2009;13(2):103–7.PubMedCrossRef

25.

Morimoto S, Yurugi T, Aota Y, Sakuma T, Jo F, Nishikawa M, et al. Prognostic significance of ankle-brachial index, brachial-ankle pulse wave velocity, flow-mediated dilation, and nitroglycerin-mediated dilation in end-stage renal disease. Am J Nephrol. 2009;30(1):55–63.PubMedCrossRef

26.

Mordasini R, Frey F, Flury W, Klose G, Greten H. Selective deficiency of hepatic triglyceride lipase in uremic patients. N Engl J Med. 1977;297(25):1362–6.PubMedCrossRef

27.

Murase T, Cattran DC, Rubenstein B, Steiner G. Inhibition of lipoprotein lipase by uremic plasma, a possible cause of hypertriglyceridemia. Metabolism. 1975;24(11):1279–86.PubMedCrossRef

28.

Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006; 29(Suppl 1):S43–8.

29.

Fan AZ. Metabolic syndrome and progression of atherosclerosis among middle-aged US adults. J Atheroscler Thromb. 2006;13(1):46–54.PubMedCrossRef

30.

Yokoyama H, Shoji T, Kimoto E, Shinohara K, Tanaka S, Koyama H, et al. Pulse wave velocity in lower-limb arteries among diabetic patients with peripheral arterial disease. J Atheroscler Thromb. 2003;10(4):253–8.PubMedCrossRef

31.

Kawagishi T, Nishizawa Y, Konishi T, Kawasaki K, Emoto M, Shoji T, et al. High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia. Kidney Int. 1995;48(3):820–6.PubMedCrossRef

32.

Excerpts from the United States Renal Data System 1998 Annual Data Report. Am J Kidney Dis. 1998;32(2 Suppl 1):S1–162.

33.

Borkan GA, Gerzof SG, Robbins AH, Hults DE, Silbert CK, Silbert JE. Assessment of abdominal fat content by computed tomography. Am J Clin Nutr. 1982;36(1):172–7.PubMed

34.

Nakamura T, Tokunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K, et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis. 1994;107(2):239–46.PubMedCrossRef

35.

Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987;36(1):54–9.PubMedCrossRef

36.

Despres JP, Lemieux S, Lamarche B, Prud’homme D, Moorjani S, Brun LD, et al. The insulin resistance-dyslipidemic syndrome: contribution of visceral obesity and therapeutic implications. Int J Obes Relat Metab Disord. 1995;19(Suppl 1):S76–86.PubMed

37.

Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982;54(2):254–60.PubMedCrossRef

38.

Cheung AK, Wu LL, Kablitz C, Leypoldt JK. Atherogenic lipids and lipoproteins in hemodialysis patients. Am J Kidney Dis. 1993;22(2):271–6.PubMed

39.

Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes. 1996;45(5):633–8.PubMedCrossRef

40.

Balkau B, Deanfield JE, Despres JP, Bassand JP, Fox KA, Smith SC Jr, et al. International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168, 000 primary care patients in 63 countries. Circulation. 2007;116(17):1942–51.PubMedCrossRef

41.

Sluik D, Boeing H, Montonen J, Pischon T, Kaaks R, Teucher B, et al. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am J Epidemiol. 2011;174(1):22–34.PubMedCrossRef

42.

Hotta K, Funahashi T, Arita Y, Takahashi M, Matsuda M, Okamoto Y, et al. Plasma concentrations of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients. Arterioscler Thromb Vasc Biol. 2000;20(6):1595–9.PubMedCrossRef

43.

Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun. 1999;257(1):79–83.PubMedCrossRef

44.

Kumada M, Kihara S, Sumitsuji S, Kawamoto T, Matsumoto S, Ouchi N, et al. Association of hypoadiponectinemia with coronary artery disease in men. Arterioscler Thromb Vasc Biol. 2003;23(1):85–9.PubMedCrossRef

45.

Odamaki M, Furuya R, Kinumura Y, Ikegaya N, Kumagai H. Association between plasma adiponectin concentration and visceral fat accumulation in hemodialysis patients. Nephron Clin Pract. 2006;102(1):c8–13.PubMedCrossRef

46.

Kaysen GA, Kotanko P, Zhu F, Sarkar SR, Heymsfield SB, Kuhlmann MK, et al. Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients. J Ren Nutr. 2009;19(5):357–64.PubMedCrossRef

47.

Zoccali C, Mallamaci F, Tripepi G, Benedetto FA, Cutrupi S, Parlongo S, et al. Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease. J Am Soc Nephrol. 2002;13(1):134–41.PubMed

48.

Ouchi N, Kihara S, Arita Y, Okamoto Y, Maeda K, Kuriyama H, et al. Adiponectin, an adipocyte-derived plasma protein, inhibits endothelial NF-kappaB signaling through a cAMP-dependent pathway. Circulation. 2000;102(11):1296–301.PubMed

49.

Ouchi N, Kihara S, Arita Y, Nishida M, Matsuyama A, Okamoto Y, et al. Adipocyte-derived plasma protein, adiponectin, suppresses lipid accumulation and class A scavenger receptor expression in human monocyte-derived macrophages. Circulation. 2001;103(8):1057–63.PubMed

50.

Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW. Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transpl. 2001;16(12):2386–94.CrossRef

Titel: Accumulation of visceral fat in maintenance hemodialysis patients
verfasst von: Takatomi Yurugi
Satoshi Morimoto
Takayuki Okamoto
Yoshifumi Amari
Yuko Kasuno
Masayoshi Fukui
Fumitaka Nakajima
Mitsushige Nishikawa
Toshiji Iwasaka
Publikationsdatum: 01.02.2012
Verlag: Springer Japan
Erschienen in: Clinical and Experimental Nephrology / Ausgabe 1/2012
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-011-0544-8

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Background

Methods

Results

Conclusions

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