Central Body Fat Distribution Associates with Unfavorable Renal Hemodynamics Independent of Body Mass Index

Kwakernaak, Arjan J.; Zelle, Dorien M.; Bakker, Stephan J. L.; Navis, Gerjan

doi:10.1681/asn.2012050460

Cited by 68 publications

(68 citation statements)

References 56 publications

(59 reference statements)

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“…However, we found no differences in circulating parameters of RAAS activity or in ANG II renal responsiveness. A higher BMI, even in the nonobese (4), and central fat distribution (14) have also been associated with hyperfiltration, but in our study, body fat distribution was similar between the groups, and the slight difference in BMI could not explain the difference in FF, as tested by multivariate analysis. Alternatively, a redistribution of RBF toward juxtacortical glomeruli, with a higher FF, could be present.…”

Section: Discussioncontrasting

confidence: 71%

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

Toering

Graaf

Visser

et al. 2015

American Journal of Physiology-Renal Physiology

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Formerly preeclamptic women have an increased risk for developing end-stage renal disease, which has been attributed to altered renal hemodynamics and abnormalities in the renin-angiotensin-aldosterone system. Whether this is due to preeclampsia itself or to comorbid conditions is unknown. Renal hemodynamics and responsiveness to ANG II during low Na ϩ intake (7 days, 50 mmol Na ϩ /24 h) and high Na ϩ (HS) intake (7 days, 200 mmol Na ϩ /24 h) were studied in 18 healthy normotensive formerly early-onset preeclamptic women (fPE women) and 18 healthy control subjects (fHP women), all selected for absence of comorbidity. At the end of each diet, renal hemodynamics and blood pressure were measured before and during graded ANG II infusion. Both HS intake and former preeclampsia increased filtration fraction (FF) without an interaction between the two. FF was highest during HS intake in fPE women [0.31 Ϯ 0.12 vs. 0.29 Ϯ 0.11 in fHP women, generalized estimating equation analysis (body mass index corrected), P ϭ 0.03]. The renal response to ANG II infusion was not different between groups. In conclusion, fPE women have a higher FF compared with fHP women. As this was observed in the absence of comorbidity, preeclampsia itself might exert long-term effects on renal hemodynamics. However, we cannot exclude the presence of prepregnancy alterations in renal function, which, in itself, lead to an increased risk for preeclampsia. In experimental studies, an elevated FF has been shown to play a pathogenic role in the development of hypertension and renal damage. Future studies, however, should evaluate whether the subtle differences in renal hemodynamics after preeclampsia contribute to the increased long-term renal risk after preeclampsia. preeclampsia; postpartum; renal hemodynamics; renin-angiotensinaldosterone system; Na ϩ intake COMPLICATING up to 8% of pregnancies, preeclampsia (PE) is a major cause of maternal and fetal morbidity and mortality worldwide (27). PE is characterized by the de novo development of hypertension and proteinuria during the second half of pregnancy. Although it is a pregnancy-specific disease, evidence has mounted that PE has important long-term implications for maternal health, in particular, cardiovascular and renal health (2,24,33). It is, however, uncertain whether the increased renal and cardiovascular risk in formerly preeclamptic women is explained by PE itself or by underlying common (prepregnant) risk factors and comorbidity. Recent data have shown that formerly preeclamptic women have a 5-to 14-fold higher risk for developing end-stage renal disease (ESRD) (33, 36). Moreover, women who experienced multiple preeclamptic pregnancies have an even higher risk for ESRD (33). The risk for developing cardiovascular disease is especially high for women who have a history of early-onset PE (before 34 wk of gestational age) (2). It is unknown whether this also applies for the risk of developing ESRD. However, in a large Norwegian cohort study, the association between former PE and developing ESRD...

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Section: Discussioncontrasting

confidence: 71%

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

Toering

Graaf

Visser

et al. 2015

American Journal of Physiology-Renal Physiology

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“…55 Other than indirect effects on kidney disease incidence and progression (by type 2 diabetes, atherosclerosis, and hypertension), adiposity may also directly impact kidney function. 56 Indeed, Kwakernaak et al 57 recently reported that a central body fat distribution was associated with an unfavorable renal hemodynamic pattern. As reviewed by Wickman and Kramer, 56 increased fat mass leads to mesangial expansion and increased renal metabolic demand that may promote glomerular hyperfiltration, glomerular hypertrophy, decreased podocyte density, increased foot processes, and increased filtration fraction (i.e., alterations that promote proteinuria and glomerulosclerosis).…”

Section: Obesity-a Preventable Risk Factor For Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

195

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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“…There are several reports examining the relationship between obesity and renal hemodynamic changes [3,5,6,8,[22][23][24][25][26]. However, the relationship between abdominal fat distribution and glomerular hyperfiltration and has not been studied to date.…”

Section: Introductionmentioning

confidence: 99%

Abdominal Adipose Tissue was Associated with Glomerular Hyperfiltration among Non- Diabetic and Normotensive Adults with a Normal Body Mass Index

Lee

Kim

Cho

et al. 2015

Journal of Hypertension

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Glomerular hyperfiltration is recognized as an early marker of progressive kidney dysfunction in the obese population. This study aimed to identify the relationship between glomerular hyperfiltration and body fat distribution measured by computed tomography (CT) in healthy Korean adults. The study population included individuals aged 20-64 years who went a routine health check-up including an abdominal CT scan. We selected 4,378 individuals without diabetes and hypertension. Glomerular filtration rate was estimated using the CKD-EPI equation, and glomerular hyperfiltration was defined as the highest quintile of glomerular filtration rate. Abdominal adipose tissue areas were measured at the level of the umbilicus using a 16-detector CT scanner, and the cross-sectional area was calculated using Rapidia 2.8 CT software. The prevalence of glomerular hyperfiltration increased significantly according to the subcutaneous adipose tissue area in men (OR = 1.74 (1.16-2.61), P for trend 0.016, for the comparisons of lowest vs. highest quartile) and visceral adipose tissue area in women (OR = 2.34 (1.46-3.75), P for trend < 0.001) in multivariate analysis. After stratification by body mass index (normal < 23 kg/m 2 , overweight 23 kg/m 2 ), male subjects with greater subcutaneous adipose tissue, even those in the normal BMI group, had a higher prevalence of glomerular hyperfiltration (OR = 2.11 (1.17-3.80), P for trend = 0.009). Among women, the significance of visceral adipose tissue area on glomerular hyperfiltration resulted from the normal BMI group (OR = 2.14 (1.31-3.49), P for trend = 0.002). After menopause, the odds ratio of the association of glomerular hyperfiltration with subcutaneous abdominal adipose tissue increased (OR = 2.96 (1.21-7.25), P for trend = 0.013). Subcutaneous adipose tissue areas and visceral adipose tissue areas are positively associated with glomerular hyperfiltration in healthy Korean adult men and women, PLOS ONE |

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Central Body Fat Distribution Associates with Unfavorable Renal Hemodynamics Independent of Body Mass Index

Cited by 68 publications

References 56 publications

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

Higher filtration fraction in formerly early-onset preeclamptic women without comorbidity

Obesity in CKD—What Should Nephrologists Know?

Abdominal Adipose Tissue was Associated with Glomerular Hyperfiltration among Non- Diabetic and Normotensive Adults with a Normal Body Mass Index

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