Visceral Fat Level Is an Independent Risk Factor for Cardiovascular Mortality in Hemodialysis Patients

Okamoto, Takayuki; Morimoto, Satoshi; Ikenoue, Tatsuyoshi; Furumatsu, Yoshiyuki; Ichihara, Atsuhiro

doi:10.1159/000358335

Cited by 31 publications

(36 citation statements)

References 27 publications

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“…30 Although, reverse epidemiology regarding BMI and survival was reported for HD patients, 31 indicating increased mortality in those with low BMI and no increased mortality in overweight and obese HD patients, more recently obesity has been registered as an independent risk factor for cardiovascular morbidity and mortality in HD patients as for the general population. 32,33 Therefore, close monitoring of body weight and maintenance of normal BMI in both HD and other elderly patients is necessary to prevent the adverse health consequences of obesity.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Račić

Petković

Bogićević³

et al. 2015

Renal Failure

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Backgrounds: The quality of life and survival of elderly depend not only on their age but on many social and health factors. In the present study, comprehensive geriatric assessment (CGA) was made in elderly patients on regular hemodialysis (HD) and those without chronic kidney disease recruited in primary health care in order to compare their sociodemographic characteristics, physical health, functional ability and social support. Method: The 106 HD patients and 300 primary care patients aged 70 years and more were studied. Data on sociodemographic characteristics, neurosensory deficits, pain, falls, polypharmacy, basic activities of daily living (ADL) questionnaire, instrumental activities of daily living (IADL) questionnaire were obtained during interview. The Timed Up and Go, Nutritional Health Checklist, Two Question Instrument for depression and Charlson comorbidity index (CCI) were applied. Results: No significant differences were found for age, gender, education level and dwelling between the two groups. A lower percentage of HD patients lived alone when compared with controls. BMI 425 kg/m 2 had 43.4% of HD patients and 49.3% of controls. CCI differed significantly between HD and primary care patients (median: 6 vs. 4) and significantly more HD patients reported depression. No significant difference was found between groups for cognitive dysfunction and ADL, but HD patients had significantly lower IADL scores than controls. The mobility of HD patients was worse; 45.7% of them reported falls in the previous year but only 9.7% from the controls. Conclusions: CGA revealed that HD patients had significantly higher CCI, worse IADL score, mobility and reported more frequent falls, depression and impaired vision than primary care patients.

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Section: Discussionmentioning

confidence: 99%

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Račić

Petković

Bogićević³

et al. 2015

Renal Failure

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“…Moreover, BMI was correlated with fat mass, but not muscle mass, in those patients [17]. High visceral fat in patients undergoing HD was also associated with increased secretion of proinflammatory cytokines and was correlated with increased CV events and mortality rate, independent of BMI [18,19]. Thus, low muscle mass and high visceral fat are expected to play important roles in CV disease and mortality risk [20].…”

Section: Doi: 101159/000492939mentioning

confidence: 98%

Fat-to-Lean Mass Ratio Can Predict Cardiac Events and All-Cause Mortality in Patients Undergoing Hemodialysis

Lee

Kim

et al. 2018

Ann Nutr Metab

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Background: Although higher body mass index (BMI) is associated with better survival in patients undergoing dialysis, BMI is not an adequate obesity indicator. We hypothesized that the fat-to-lean (F/L) mass ratio could be a suitable marker of nutritional status and evaluated its prognostic impact on long-term outcomes in patients undergoing hemodialysis (HD). Methods: In total, 131 patients undergoing HD were recruited and monitored prospectively for up to 5 years. Body composition was analyzed, and other nutritional and inflammatory parameters were measured. Results: The mean age of the cohort was 60.7 ± 13.6 years, and 65 patients were diabetic. Age, sex, diabetes, comorbidity, and inflammation were associated significantly with the F/L mass ratio. During the follow-up period, 21 patients experienced cardiac events and 22 patients died. Patients with higher F/L mass ratios had significantly higher risks of all-cause death (hazard ratio [HR] 3.61, 95% CI 1.07–12.13; p = 0.038) and cardiac events (HR 3.54, 95% CI 1.05-11.94; p = 0.041) than those with lower F/L mass ratios. Conclusions: The F/L mass ratio was a useful surrogate marker of nutritional and inflammatory status, and an independent predictor of cardiac events and all-cause mortality, in patients undergoing HD.

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“…Abdominal visceral adipose tissue (VAT) measures from computed tomography (CT) scans have been shown to predict subsequent cardiovascular disease events(1–4), and may be a risk factor for cognitive decline(5, 6). These associations are postulated to be mediated in part through raised inflammatory cytokines and insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Associations of DXA and CT Visceral Adipose Tissue Measures With Insulin Resistance, Lipid Levels, and Inflammatory Markers

Schousboe

Langsetmo

Schwartz

et al. 2017

Journal of Clinical Densitometry

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Background Visceral adipose tissue (VAT) measured by computed tomography (CT) is related to insulin resistance, lipids, and serum inflammatory markers. Our objective was to compare the strength of the associations of visceral adipose tissue (VAT) measured with dual energy x-ray absorptiometry (DXA-VAT) and computed tomography (CT-VAT) with insulin resistance, serum lipids, and serum markers of inflammation. Methodology For 1,117 men age 65 and older enrolled in the Study of Osteoporotic Fractures in Men (MrOS), the cross-sectional associations of DXA-VAT and CT-VAT with Homeostasis Model Assessment of insulin resistance (homa2ir), C-reactive protein (CRP), and HDL cholesterol were estimated with regression models, and compared using a Hausmann test. Results Adjusted for age and body mass index (BMI), DXA-VAT was moderately associated with homa2ir (effect size 0.38, 95% C.I. 0.28 to 0.47) and modestly associated with HDL cholesterol (DXA effect size −0.29, 95% C.I. −0.38 to −0.21). These associations were significantly greater than for CT-VAT with homa2ir (0.30, 95% C.I. 0.24 to 0.37; p-value for effect size difference 0.03) and CT-VAT with HDL cholesterol (-0.22, 95% C.I. −0.29 to −0.15; p-value for difference 0.005). Neither DXA-VAT nor CT-VAT were associated with CRP after adjustment for age and BMI (DXA-VAT effect size 0.14, 95% C.I. −0.04 to 0.32; CT-VAT effect size 0.08, 95% C.I. −0.08 to 0.25; p-value for difference 0.35). Conclusion DXA-VAT has similar or greater associations with insulin resistance, and HDL cholesterol as does CT-VAT in older men, confirming the concurrent validity of DXA-VAT. Investigations of how well DXA measurements of VAT predict incident cardiovascular disease events are warranted.

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Visceral Fat Level Is an Independent Risk Factor for Cardiovascular Mortality in Hemodialysis Patients

Cited by 31 publications

References 27 publications

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Fat-to-Lean Mass Ratio Can Predict Cardiac Events and All-Cause Mortality in Patients Undergoing Hemodialysis

Comparison of Associations of DXA and CT Visceral Adipose Tissue Measures With Insulin Resistance, Lipid Levels, and Inflammatory Markers

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