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      Perirenal fat thickness is associated with metabolic risk factors in patients with chronic kidney disease

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          Abstract

          Background

          Adipose tissue accumulation in specific body compartments has been associated with diabetes, hypertension and dyslipidemia. Perirenal fat (PRF) may lead to have direct lipotoxic effects on renal function and intrarenal hydrostatic pressure. This study was undertaken to explore the association of PRF with cardiovascular risk factors and different stages of chronic kidney disease (CKD).

          Methods

          We studied 103 patients with CKD of different stages (1 to 5). PRF was measured by B-mode renal ultrasonography in the distal third between the cortex and the hepatic border and/or spleen.

          Results

          The PRF thickness was greater in CKD patients with impaired fasting glucose than in those with normal glucose levels (1.10 ± 0.40 cm vs. 0.85 ± 0.39 cm, P < 0.01). Patients in CKD stages 4 and 5 (glomerular filtration rate [GFR] < 30 mL/min/1.73 m 2) had the highest PRF thickness. Serum triglyceride levels correlated positively with the PRF thickness; the PRF thickness was greater in patients with triglyceride levels ≥ 150 mg/dL (1.09 ± 0.40 cm vs. 0.86 ± 0.36 cm, P < 0.01). In patients with a GFR < 60 mL/min/1.73 m 2, uric acid levels correlated positively with the PRF thickness ( P < 0.05).

          Conclusion

          In CKD patients, the PRF thickness correlated significantly with metabolic risk factors that could affect kidney function.

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          Most cited references30

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          Chronic kidney disease and mortality risk: a systematic review.

          Current guidelines identify people with chronic kidney disease (CKD) as being at high risk for cardiovascular and all-cause mortality. Because as many as 19 million Americans may have CKD, a comprehensive summary of this risk would be potentially useful for planning public health policy. A systematic review of the association between non-dialysis-dependent CKD and the risk for all-cause and cardiovascular mortality was conducted. Patient- and study-related characteristics that influenced the magnitude of these associations also were investigated. MEDLINE and EMBASE databases were searched, and reference lists through December 2004 were consulted. Authors of 10 primary studies provided additional data. Cohort studies or cohort analyses of randomized, controlled trials that compared mortality between those with and without chronically reduced kidney function were included. Studies were excluded from review when participants were followed for < 1 yr or had ESRD. Two reviewers independently extracted data on study setting, quality, participant and renal function characteristics, and outcomes. Thirty-nine studies that followed a total of 1,371,990 participants were reviewed. The unadjusted relative risk for mortality in participants with reduced kidney function compared with those without ranged from 0.94 to 5.0 and was significantly more than 1.0 in 93% of cohorts. Among the 16 studies that provided suitable data, the absolute risk for death increased exponentially with decreasing renal function. Fourteen cohorts described the risk for mortality from reduced kidney function, after adjustment for other established risk factors. Although adjusted relative hazards were consistently lower than unadjusted relative risks (median reduction 17%), they remained significantly more than 1.0 in 71% of cohorts. This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.
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            Chronic kidney disease: effects on the cardiovascular system.

            Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.
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              Elevated uric acid increases the risk for kidney disease.

              Recent epidemiologic studies suggest that uric acid predicts the development of new-onset kidney disease, but it is unclear whether uric acid is an independent risk factor. In this study, data from 21,475 healthy volunteers who were followed prospectively for a median of 7 yr were analyzed to examine the association between uric acid level and incident kidney disease (estimated GFR [eGFR] or =9.0 mg/dl) was associated with a tripled risk (odds ratio 3.12; 95% confidence interval 2.29 to 4.25). These increases in risk remained significant even after adjustment for baseline eGFR, gender, age, antihypertensive drugs, and components of the metabolic syndrome (waist circumference, HDL cholesterol, blood glucose, triglycerides, and BP). In a fully adjusted spline model, the risk for incident kidney disease increased roughly linearly with uric acid level to a level of approximately 6 to 7 mg/dl in women and 7 to 8 mg/dl in men; above these levels, the associated risk increased rapidly. In conclusion, elevated levels of uric acid independently increase the risk for new-onset kidney disease.
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                Author and article information

                Journal
                Kidney Res Clin Pract
                Kidney Res Clin Pract
                Kidney Research and Clinical Practice
                Korean Society of Nephrology
                2211-9132
                2211-9140
                September 2019
                30 September 2019
                : 38
                : 3
                : 365-372
                Affiliations
                [1 ]Consorci Sanitari del Garraf, Servicio de Nefrología, Barcelona, Spain
                [2 ]Advanced Unit of Renal Sonographic Diagnostics, Puerto Ordaz Clinic, Puerto Ordaz City, Venezuela
                [3 ]Department of Physiological Sciences, Universidad de Oriente, Bolívar, Venezuela
                [4 ]Universidad Simon Bolívar Facultad de Ciencias de la Salud, Barranquilla, Colombia
                [5 ]Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
                Author notes
                Correspondence: Luis D’Marco, Consorci Sanitari del Garraf, Servicio de Nefrología, Barcelona 08811, Spain. E-mail: luisgerardodg@ 123456hotmail.com

                Edited by Won Kim, Chonbuk National University, Jeonju, Korea

                Author information
                https://orcid.org/0000-0003-0148-891X
                https://orcid.org/0000-0001-7963-7466
                https://orcid.org/0000-0001-9541-721X
                https://orcid.org/0000-0003-2535-9549
                https://orcid.org/0000-0001-8028-280X
                https://orcid.org/0000-0001-7450-5237
                https://orcid.org/0000-0003-1345-942X
                https://orcid.org/0000-0002-2253-0833
                https://orcid.org/0000-0003-1880-8887
                Article
                krcp-38-365
                10.23876/j.krcp.18.0155
                6727893
                31357262
                2fa9a27f-d24e-413b-88cd-5c66d3960bc4
                Copyright © 2019 by The Korean Society of Nephrology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 December 2018
                : 30 March 2019
                : 11 April 2019
                Categories
                Original Article

                cardiovascular,chronic kidney disease,diabetes,metabolic risk,perirenal fat,renal insufficiency

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