Visceral obesity assessed by computed tomography predicts cardiovascular events in chronic kidney disease patients

Kamimura, Maria Ayako; Carrero, Juan Jesús; Canziani, María Eugênia Fernandes; Watanabe, Renato; Lemos, Marcelo M.; Cuppari, Lílian

doi:10.1016/j.numecd.2012.06.004

Cited by 33 publications

(33 citation statements)

References 32 publications

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“…Conversely, our group [35,36] and others [37,38] have demonstrated that the accumulation of abdominal fat has a negative impact on cardiovascular disease and mortality in this population of patients. Given this controversial issue, it is not clear which type of intervention would be more appropriate for obese CKD patients.…”

Section: Discussionmentioning

confidence: 87%

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

et al. 2014

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Section: Discussionmentioning

confidence: 87%

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

et al. 2014

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Section: Introductionmentioning

confidence: 99%

“…Several recent studies have examined the association of the amount of visceral adipose tissue with outcomes [31,32 ■ ,33 ■■ ]. In a study that enrolled 65 patients with stages 3 and 4 CKD from Brazil [31,32 ■ ], visceral and subcutaneous fat areas were calculated from abdominal computed tomography. Patients were considered to have visceral obesity if the ratio of visceral to subcutaneous adipose area was greater than the median, and the presence of visceral obesity was associated with higher coronary artery calcification (CAC) score [31] and higher risk of cardiovascular events [32 ■ ].…”

Section: Introductionmentioning

confidence: 99%

“…In a study that enrolled 65 patients with stages 3 and 4 CKD from Brazil [31,32 ■ ], visceral and subcutaneous fat areas were calculated from abdominal computed tomography. Patients were considered to have visceral obesity if the ratio of visceral to subcutaneous adipose area was greater than the median, and the presence of visceral obesity was associated with higher coronary artery calcification (CAC) score [31] and higher risk of cardiovascular events [32 ■ ]. A follow-up analysis with a larger number of patients confirmed that greater amounts of visceral adipose tissue were associated with clinically significant coronary calcification and showed that waist circumference as a surrogate for visceral adiposity was also associated with coronary calcification [33 ■■ ].…”

Section: Introductionmentioning

confidence: 99%

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Body composition in chronic kidney disease

Johansen¹,

Lee²

2015

Current Opinion in Nephrology and Hypertension

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Purpose of review To summarize the latest information on body composition among patients with chronic kidney disease and its association with outcomes. Recent findings Obesity is increasing among patients with end-stage renal disease and is more prevalent when direct measures of adiposity are used rather than BMI. High BMI is not associated with better survival among patients with earlier chronic kidney disease or after kidney transplantation, suggesting that excess fat is most protective among the sickest patients. Despite the positive association between BMI and survival among patients with end-stage renal disease, visceral fat is associated with coronary artery calcification and adverse cardiovascular events. Muscle wasting is prominent among patients with chronic kidney disease, sometimes even in the setting of obesity. Obesity and muscle wasting are associated with worse physical functioning. Indicators of low muscle size and strength are associated with higher mortality. Some interventions can affect body composition, but whether they affect survival has not been determined. Summary Recent studies show that a high BMI is not protective for all patients with chronic kidney disease and is associated with poor physical functioning and frailty. Visceral adiposity is associated with adverse cardiovascular outcomes. Sarcopenia is common among patients with end-stage renal disease and is associated with worse physical performance and higher mortality.

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“…We previously reported that the incidence of high VFA was markedly higher than that of high BMI, high low-density lipoprotein cholesterol (LDL-C) or high triglycerides, and VFA was shown to be associated with both arterial stiffness and atherosclerosis in diabetic patients on maintenance HD [9]. Visceral obesity assessed by CT is a predictor of cardiovascular events in nondialysis chronic kidney disease patients [10]. However, whether high VFA is associated with increased cardiovascular mortality in dialysis patients remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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Background: Obesity is an independent risk factor for morbidity and mortality in cardiovascular diseases not only in the general population, but also in hemodialysis (HD) patients. We previously reported that an increased visceral fat area (VFA) determined using computed tomography (CT) scans was associated with atherosclerosis in HD patients. However, whether a high VFA is associated with increased cardiovascular mortality in HD patients remains unknown. Therefore, we investigated the relationship between VFA and prognosis in HD patients. Methods: VFA was estimated in 126 patients on maintenance HD using CT scans. These patients were followed for 60 months. Results: Kaplan-Meier analysis revealed that the cardiovascular survival rate was significantly lower in the high-VFA group, with a VFA of 71.5 cm² or greater, than in the low-VFA group, with a VFA of less than 71.5cm². In univariate Cox proportional hazards analyses, age, albumin, low-density lipoprotein cholesterol, cardio-thoracic ratio and VFA above 71.5 cm² were significantly correlated with cardiovascular deaths. In multivariate analyses testing these factors as dependent variables, VFA above 71.5 cm² was estimated to be an independent predictor of cardiovascular deaths. Conclusion: These results suggest that an increased VFA is a stronger risk factor for cardiovascular deaths in HD patients. Measuring VFA may be recommended for predicting the risk of cardiovascular diseases in HD patients.

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Visceral obesity assessed by computed tomography predicts cardiovascular events in chronic kidney disease patients

Cited by 33 publications

References 32 publications

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

Body composition in chronic kidney disease

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

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