Cardiorenal Fat: A Cardiovascular Risk Factor With Implications in Chronic Kidney Disease

Abstract

There is a growing interest in the potential role of adipose tissues in cardiac and renal pathophysiology, and determining the mechanisms by which fat compartments around the heart and kidneys influence cardiovascular disease is of clinical importance in both general and high-risk populations. Epicardial fat and perirenal fat have been associated with adverse outcomes in chronic kidney disease (CKD) patients. Epicardial fat is a rich source of free fatty acids and is capable of secreting inflammatory and pro-atherogenic cytokines that promote atherosclerosis through a local paracrine effect. Recent evidence has demonstrated that perirenal fat has a closer correlation with kidney diseases than other visceral fat deposits in obesity or metabolic disturbances. Moreover, perirenal fat has been reported as an independent risk factor for CKD progression and even associated with cardiorenal dysfunction. Accordingly, these forms of organ-specific fat deposits may act as a connecter between vascular and cardiorenal disease. This review explores the possible links between epicardial and perirenal fat and its significant role as a modulator of cardiorenal dysfunction in CKD patients.

Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease

“…Fatty kidney comprises perirenal, sinus, and renal parenchyma fat [166][167][168][169]. Perirenal and sinus fat volumes can be measured with a variety of high-resolution MRI techniques to visualize the renal facia that separate perirenal fat from the pararenal depot.…”

Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events (MACE) and mortality in patients with heart disease and critically ill patients. Part I: Epicardial adipose tissue

“…Studies have associated EAT volume with unfavourable clinical outcomes in chronic kidney disease (CKD) [ 64 , 65 ]. Interestingly, analogously to the way that EAT is an organ-specific adipose tissue impacting the heart, there is growing evidence that the perirenal adipose tissue (PF) has a significant impact on renal pathophysiology [ 66 ]. It was demonstrated that PF is an independent predictor for CKD progression and is associated with cardiorenal dysfunction [ 67 ].…”

Fatty kidney: A possible future for chronic kidney disease research

“…Epicardial fat accumulation has been linked to poor consequences including albuminuria, decline in eGFR, atherosclerosis and worse prognosis in CKD patients. [108][109][110][111] Exact physiological role of epicardial fat accumulation is currently unclear; nevertheless, it is involved in the secretion of many cytokines such as leptin, adiponectin, resistin, omentin and others. Under physiological conditions, the balance of these cytokines supports anti-inflammatory and anti-atherogenic effects while excess accumulation of epicardial fat accumulation leads to contradictory outcomes like fat accumulation in many other tissues including liver, kidney and subcutaneous tissues.…”

“…Another important issue to be addressed is the potential effects of fat accumulation in other tissues including epicardium on cardio‐renal outcomes. Epicardial fat accumulation has been linked to poor consequences including albuminuria, decline in eGFR, atherosclerosis and worse prognosis in CKD patients 108–111 . Exact physiological role of epicardial fat accumulation is currently unclear; nevertheless, it is involved in the secretion of many cytokines such as leptin, adiponectin, resistin, omentin and others.…”