The Association Between Hypertriglyceridemic-Waist Phenotype and Chronic Kidney Disease in Patients with Type 2 Diabetes: A Cross-Sectional METAL Study

Abstract

The aim of this study was measuring the association between the hypertriglyceridemic-waist (HTGW) phenotype and chronic kidney disease in a large type 2 diabetes population. Methods: A total of 4254 diabetic patients from the cross-sectional Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study were enrolled. The hypertriglyceridemic-waist (HTGW) phenotype was defined as the presence of an elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m 2 or urinary albumin creatinine ratio (uACR) more than 30 mg/g. Linear and multiple logistic regression models were used for measuring the association between HTGW phenotype and chronic kidney disease. Results: The prevalence of CKD was 29% and 35.8% in total participants and participants with HTGW phenotype, respectively. Subjects in the HTGW phenotype group were more likely to have CKD (OR 1.47, 95% CI: 1.11, 1.95) compared with subjects in the normal waist circumference and normal triglycerides (NTNW) group. HTGW phenotype was both associated with the increasing risk of decreased eGFR (OR 1.31, 95% CI: 1.02, 1.75) and elevated uACR (OR 1.57, 95% CI: 1.18, 2.11). Furthermore, the stratified analysis showed that the strongest positive association between HTGW phenotype and CKD presence was found in the subgroup of presence of hypertension. The associations were all fully adjusted for age, sex, BMI, current smoking, current drinking and other confounding factors. Conclusion:Our study suggested a positive association between the HTGW phenotype and CKD in Chinese type 2 diabetes patients. Further prospective studies are needed to confirm our findings and to investigate the underlying biological mechanisms.

Clinicopathological Characteristics and Risk Factors for Rapid eGFR Decline in Chinese Patients with Biopsy-Proven Obesity-Related Glomerulopathy

“…27 Other factors including insulin resistance, oxidative stress and genetics may also affect to different degrees. 28 Consistent with previous studies, [10][11][12] our data showed that the use of ACEI/ARB was not independently correlated with renal outcome in ORG patients. Except for the influence of possible body weight gain in the follow-up time, the occurrence of aldosterone escape may explain the result.…”

Association of Hyper-Triglyceridemic Waist Phenotype and Diabetic Vascular Complication in the Chinese Population

“… 10 The result of CKD-related vascular complications was consistent with Yan’s study. 25 However, we did not find an association between HWP and DR.…”

“…26,27 Visceral fat cells stimulate the secretion of inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and adipokines, which lead to the production of reactive oxygen in arterioles. 25 Therefore, pro-inflammatory cytokines and reactive oxygen species produced by obesity can directly affect endothelial cells, leading to endothelial dysfunction. 28 In our study, there was an age difference in the result between HWP and vascular complications of diabetes.…”

Relationship between Phenotype Models Based on Waist Circumference and Triglyceride Levels and the Risk of Chronic Kidney Disease: A Systematic Review and Meta-analysis

“…Of those 20 full-text articles, seven were excluded for the following reasons: six articles did not have data on the outcome of interest, and one article was not in the English language. Therefore, the remaining 13 articles, [16][17][18][23][24][25][26][27][28][29][30][31][32] which together had 113,019 participants, were included in the analyses (Fig. 1).…”