Metabolic syndrome and abdominal fat are associated with inflammation, but not with clinical outcomes, in peritoneal dialysis patients

Abstract

BackgroundIn the general population, metabolic syndrome (MetS) is correlated with visceral fat and a risk factor for cardiovascular disease (CVD); however, little is known about the significance of abdominal fat and its association with inflammation and medication use in peritoneal dialysis (PD) patients. We investigated the relationship of visceral fat area (VFA) with C-reactive protein (CRP) levels and medication use in PD patients and followed their clinical outcomes.MethodsIn a prospective study from February 2009 to February 2012, we assessed diabetes mellitus (DM) status, clinical and PD-associated characteristics, medication use, CRP levels, components of MetS, and VFA in 183 PD patients. These patients were categorized into 3 groups based on MetS and DM status: non-MetS (group 1, n = 73), MetS (group 2, n = 65), and DM (group 3, n = 45). VFA was evaluated by computed tomography (CT) and corrected for body mass index (BMI).ResultsPatients in group 1 had smaller VFAs than patients in groups 2 and 3 (3.2 ± 1.8, 4.6 ± 1.9, and 4.9 ± 2.0 cm2/[kg/m2], respectively, P < 0.05) and lower CRP levels (0.97 ± 2.31, 1.27 ± 2.57, and 1.11 ± 1.35 mg/dL, respectively, P < 0.05). VFA increased with the number of criteria met for MetS. After adjusting for age, body weight, and sex, CRP and albumin levels functioned as independent positive predictors of VFA; on other hand, the use of renin-angiotensin system blockers was inversely correlated with VFA in PD patients without DM. In the survival analysis, DM patients (group 3) had the poorest survival among the 3 groups, but no significant differences were found between groups 1 and 2.ConclusionThis study showed that VFA and MetS are associated with CRP levels but cannot predict survival in PD patients without DM. The complex relationship of nutritional parameters to VFA and MetS may explain these results. The type of antihypertensive medication used was also associated with the VFA. The mechanisms behind these findings warrant further investigation.

Educational level and chronic inflammation in the elderly – the role of obesity: results from the population‐based CARLA study

“…The considerable contribution of obesity in general to chronic inflammation in our cohort is surprising and partly in contrast to previous studies describing abdominal/visceral fat as the primary contributor to chronic inflammation . However, the WHR correlation with visceral fat mass was considerably weaker than with the WHeR or the BMI in a collective of the general population, limiting the usefulness of WHR to assess visceral fat mass .…”

Visceral adiposity index and risks of cardiovascular events and mortality in prevalent hemodialysis patients

“…First, we did not perform other machine-based assessments of visceral adiposity such as computed tomography or dual energy X-ray absorptiometry to validate the role of the VAI in measuring visceral adiposity in HD patients. Second, the annual mortality rate in this study was similar to our previously report [ 26 ] and to another study from Taiwan [ 40 ] in dialysis patients, but lower than reported in Western counties [ 10 ]. Furthermore, 34 patients (6.9%) in this study were censored because they were transferred to other dialysis facilities and were no longer followed up, and therefore the annual mortality rate may have been underestimated and the results of the consequent Cox survival analysis may be inaccurate.…”

Influence of Residual Renal Function in Carotid Modeling as a Marker of Early Atherosclerosis in Dialysis Patients

“…It should be pointed out that atherosclerosis tended to be less prevalent in our PD patients and neither inflammatory markers nor lipid levels were found to be independent risk factors for atherosclerosis, although CRP and fibrinogen levels were higher, serum albumin was lower in PD patients (Table 1) and serum cholesterol and lipoprotein (a) levels were similar to HD patients, a condition reported to be associated with a higher risk of developing atherosclerosis in PD therapy (27,28).…”