Zelal Adibelli

The association between visceral adiposity index levels and the change of the glomerular filtration rate in patients with chronic kidney disease

Obesity is an expanding health challenge due to its increasing prevalence across the world. Obesity is associated with chronic kidney disease (CKD) with the advancement of diabetes mellitus (DM) and hypertension (HT), causing CKD by affecting the kidneys directly. The visceral adiposity index (VAI) has recently been developed to assess the metabolic function of visceral adipose tissue (VAT). Previous studies demonstrated that the prevalence of VAI was associated with CKD. The present study aimed to investigate the association between the decline of estimated glomerular filtration rate (eGFR) and VAT. Followed in the Nephrology Department of Research and Training Hospital for one year, 129 patients aged between 18-80 years with stages 2-5 CKD and not on dialysis were enrolled into the study. Sixty-three (40.6%) patients were females, and the mean age was 66.8 years. The averages of decreased eGFR and VAI values were also found as 12.8±19.0 mL/min/1.73 m2 and 2.86±1.63, respectively. The values of VAI were not correlated with the decrease in eGFR. The VAI values (p=0.03) and eGFR decrease (p=0.04) were higher in those with DM. Developed to indicate the metabolic effect of VAT, VAI has shown no association with the one-year decrease of eGFR in those with CKD.

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1. Flegal KM, Kruszon-Moran D, Carroll MD,et al. Trends in obesity among adults in the united states, 2005 to 2014. JAMA. 2016;7;315:2284-91.
2. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33:673-89.
3. Ural D, Kılıçkap M, Göksülük H, et al. Data on prevalence of obesity and waist circumference in Turkey: Systematic review, meta-analysis, and meta-regression of epidemiological studies on cardiovascular risk factors. Turk Kardiyol Dern Ars. 2018;46:577-90.
4. Ruan, X.Z., Z. Varghese, and J.F. Moorhead, An update on the lipid nephrotoxicity hypothesis. Nat Rev Nephrol, 2009. 5:713-21.
5. Ruster, C. and G. Wolf, The role of the renin-angiotensin-aldosterone system in obesity-related renal diseases. Semin Nephrol, 2013.33:44-53.
6. Kramer H, Luke A, Bidani A, et al . Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis. 2005;46:587-94.
7. Wang, H., Y.E. Chen, and D.T. Eitzman, Imaging body fat: techniques and cardiometabolic implications. Arterioscler Thromb Vasc Biol, 2014. 34: 2217-23.
8. Amato MC, Giordano C. Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol. 2014;2014:730827.
9. Xu X, Zhao Y, Zhao Z, et al. Correlation of visceral adiposity index with chronic kidney disease in the People's Republic of China: to rediscover the new clinical potential of an old indicator for visceral obesity. Ther Clin Risk Manag. 2016,29;12:489-94.
10. Huang J, Zhou C, Li Y, et al. Visceral adiposity index, hypertriglyceridemic waist phenotype and chronic kidney disease in a southern Chinese population: a cross-sectional study. Int Urol Nephrol. 2015;47:1387-96.
11. Dai D, Chang Y, Chen Y, et al. Visceral Adiposity Index, and Lipid Accumulation Product Index: Two Alternate Body Indices to Identify Chronic Kidney Disease among the Rural Population in Northeast China. Int J Environ Res Public Health. 2016;13:1231.
12. Iseki K, Ikemiya Y, Kinjo K, et al. Body mass index and the risk of development of end-stage renal disease in a screened cohort. Kidney Int. 2004;65:1870-6.
13. Lew QJ, Jafar TH, Talaei M, et al. Increased body mass index is a risk factor for end-stage renal disease in the Chinese Singapore population. Kidney Int. 2017;92:979-987.
14. Lu JL, Kalantar-Zadeh K, Ma JZ, et al. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol. 2014;25:2088-96.
15. Kramer H, Gutiérrez OM, Judd SE, et al. Waist Circumference, Body Mass Index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2016;67:62-9.
16. Zoppini G, Targher G, Chonchol M, et al. Predictors of estimated GFR decline in patients with type 2 diabetes and preserved kidney function. Clin J Am Soc Nephrol. 2012;7:401-8.
17. Yokoyama H, Tomonaga O, Hirayama M, et al. Predictors of the progression of diabetic nephropathy and the beneficial effect of angiotensin-converting enzyme inhibitors in NIDDM patients. Diabetologia. 1997;40:405-11.
18. Chue CD, Edwards NC, Davis LJ, et al. Serum phosphate but not pulse wave velocity predicts a decline in renal function in patients with early chronic kidney disease. Nephrol Dial Transplant. 2011;26:2576-82.
19. Zoccali C, Ruggenenti P, Perna A, et al. REIN Study Group. Phosphate may promote CKD progression and attenuate the renoprotective effect of ACE inhibition. J Am Soc Nephrol. 2011;22:1923-30.
20. Peralta CA, Norris KC, Li S, et al. KEEP Investigators. Blood pressure components and end-stage renal disease in persons with chronic kidney disease: the Kidney Early Evaluation Program (KEEP). Arch Intern Med. 2012;9;172:41-7.
21. Yokoyama H, Kanno S, Takahashi S, et al. Determinants of decline in glomerular filtration rate in non-proteinuric subjects with or without diabetes and hypertension. Clin J Am Soc Nephrol. 2009;4:1432-40.
22. Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;20;345:861-9.
23. Bakris GL, Weir MR, Shanifar S, et al. RENAAL Study Group. Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study. Arch Intern Med. 2003;14;163:1555-65.
24. Jafar TH, Stark PC, Schmid CH, et al. AIPRD Study Group. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003;19;139:244-52.
25. Rossing K, Christensen PK, Hovind P, et al. Progression of nephropathy in type 2 diabetic patients. Kidney Int. 2004;66:1596-605.
26. Perkovic V, Heerspink HL, Chalmers J, et al. ADVANCE Collaborative Group. Intensive glucose control improves kidney outcomes in patients with type 2 diabetes. Kidney Int. 2013;83:517-23.
27. Mann JF, Gerstein HC, Pogue J, et al. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001;17;134:629-36.
28. Perkovic V, Ninomiya T, Arima H, et al. Chronic kidney disease, cardiovascular events, and the effects of perindopril-based blood pressure lowering: data from the PROGRESS study. J Am Soc Nephrol. 2007;18:2766-72.
29. Ruggenenti P, Perna A, Gherardi G, et al. Renoprotective properties of ACEinhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999;31;354:359-64.