International Urology and Nephrology

, Volume 49, Issue 7, pp 1251–1260 | Cite as

Central obesity and risks of cardiovascular events and mortality in prevalent hemodialysis patients

  • Heba Wahid El Said
  • Osama Mahmoud Mohamed
  • Tamer Wahid El Said
  • Ahmed Bahaa El Serwi
Nephrology - Original Paper

Abstract

Background

To date, no attempt has been made to assess the best anthropometric method for defining abdominal adiposity in hemodialysis (HD) patients or to determine whether the quantity of intra-abdominal fat relates to morbidity and mortality in that population. We aimed to describe the prevalence of central obesity in HD patients and to investigate the relationship between central obesity assessed by anthropometric variables, and composite outcomes, cardiovascular morbidity and mortality among HD patients and whether this parameter correlates with intra-abdominal fat assessed by computed tomography scan (CT scan).

Methods

The procedures followed were in accord with the ethical standards of the committee on human experimentation of our institution. Informed oral consent was obtained from all patients. This was a cross-sectional study of 120 prevalent HD patients. Anthropometric measurements including body mass index, conicity index (Ci), waist–hip ratio (WHR), waist circumference (WC), waist-to-height ratio (WHtR), and visceral adiposity index (VAI) were recorded. Visceral and subcutaneous abdominal fat were assessed by CT scan. Comorbidity was scored for both the Charlson comorbidity index (CCI) and Davies comorbidity index.

Results

Twenty-eight patients (23.3%) were centrally obese based on anthropometry. By linear regression analysis, Ci, WHR, and VAI were predictors of CT assessed central obesity; p 0.042, 0.001, and 0.010, respectively. On assessment of the relationship between the abdominal obesity and the comorbidity indices, there was a positive significant correlation between Ci and CCI (p 0.025) and Davies score (p 0.002) which are predictors of mortality. During the mean follow-up period (3.2 years), 56 patients reached the composite outcome; eight patients died and 48 experienced CV events. Central obesity measured by anthropometry was a predictor of composite outcomes, cardiovascular morbidity, and mortality in HD patients by regression analysis and cox regression model. Only WC and WHtR did not predict mortality.

Conclusion

Ci, WHR, and VAI are cheap alternatives for accurate assessment of morbidity and mortality risk in centrally obese prevalent HD patients.

Keywords

Central obesity Morbidity Hemodialysis 

References

  1. 1.
    Zoccali C, Mallamaci F (2011) Does adipose tissue have a key role in inflammation in CKD? J Intern Med 269:407–409CrossRefPubMedGoogle Scholar
  2. 2.
    Lowrie EG, Li Z, Ofsthun N, Lazarus JM (2002) Body size, dialysis dose and death risk relationships among hemodialysis patients. Kidney Int 62:1891–1897CrossRefPubMedGoogle Scholar
  3. 3.
    Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW (2001) Body mass index and mortality in’healthier’ as compared with’sicker’ hemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transpl 16:2386–2394CrossRefGoogle Scholar
  4. 4.
    Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC (2004) Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 43:1439–1444CrossRefPubMedGoogle Scholar
  5. 5.
    McDonald SP, Collins JF, Johnson DW (2003) Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol 14:2894–2901CrossRefPubMedGoogle Scholar
  6. 6.
    Kaizu Y, Tsunega Y, Yoneyama T, Sakao T, Hibi I, Miyaji K (1998) Overweight as another nutritional risk factor for the long-term survival of non-diabetic hemodialysis patients. Clin Nephrol 50:44–50PubMedGoogle Scholar
  7. 7.
    de Mutsert R, Snijder MB, van der Sman-de Beer F, Seidell JC, Boeschoten EW, Krediet RT (2007) Association between body mass index and mortality is similar in the hemodialysis population and the general population at high age and equal duration of follow-up. J Am Soc Nephrol 18:967–974CrossRefPubMedGoogle Scholar
  8. 8.
    Johansen KL, Young B, Kaysen GA, Chertow GM (2004) Association of body size with outcomes among patients beginning dialysis. Am J Clin Nutr 80:324–332PubMedGoogle Scholar
  9. 9.
    Beddhu S, Pappas LM, Ramkumar N, Samore M (2003) Effects of body size and body composition on survival in hemodialysis patients. J Am Soc Nephrol 14:2366–2372CrossRefPubMedGoogle Scholar
  10. 10.
    Araujo IC, Kamimura MA, Draibe SA, Canziani ME, Manfredi SR, Avesani CM (2006) Nutritional parameters and mortality in incident hemodialysis patients. J Ren Nutr 16:27–35CrossRefPubMedGoogle Scholar
  11. 11.
    Agarwal R, Bills JE, Light RP (2010) Diagnosing obesity by body mass index in chronic kidney disease: an explanation for the “obesity paradox?”. Hypertension 56:893–900CrossRefPubMedGoogle Scholar
  12. 12.
    Pitanga FJG, Lessa I (2005) Anthropometric indexes of obesity as an instrument of screening for high coronary risk in adults in the city of Salvador-Bahia. Arq Bras Cardiol 85(1):26–31CrossRefPubMedGoogle Scholar
  13. 13.
    Hermann S, Rohrmann S, Linseisen J (2011) The association of education with body mass index and waist circumference in the EPIC-PANACEA study. BMC Public Health 11(1):1–12CrossRefGoogle Scholar
  14. 14.
    Hu F (2008) Measurements of adiposity and body composition. In: Hu F (ed) Obesity epidemiology. Oxford University Press, New York City, pp 53–83CrossRefGoogle Scholar
  15. 15.
    Kaur K, Mogra R (2006) Association of body mass index, body fat and hypertension among postmenopausal women. J Hum Ecol 20(3):171–175Google Scholar
  16. 16.
    Cordeiro AC, Qureshi AR, Stenvinkel P (2010) Abdominal fat deposition is associated with increased inflammation, protein-energy wasting and worse outcome in patients undergoing hemodialysis. Nephrol Dial Transpl 25(2):562–568CrossRefGoogle Scholar
  17. 17.
    Ho S-Y, Lam T-H, Janus ED (2003) Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol 13:683–691CrossRefPubMedGoogle Scholar
  18. 18.
    Flora MS, Mascie-Taylor CGN, Rahman M (2009) Conicity index of adult bangladeshi population and their socio-demographic characteristics. Ibrahim Med Coll J 3(1):1–8CrossRefGoogle Scholar
  19. 19.
    Hodge AM, Maple-Brown L, Cunningham J, Dunbar T, Weeramanthri T (2010) Abdominal obesity and other risk factors largely explain the high CRP in Indigenous Australians relative to the general population, but not gender differences: a cross-sectional study. BMC Public Health 10(1):700CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Liu Y, Tong G, Tong W, Lu L, Qin X (2011) Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese Subjects? BMC Public Health 11(35):1–10Google Scholar
  21. 21.
    Zoccali C, Seck SM, Mallamaci F (2011) Obesity and the epidemiology and prevention of kidney disease: waist circumference versus body mass index. Am J Kidney Dis 58(2):177–185CrossRefGoogle Scholar
  22. 22.
    de Moutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW, NECOSAD Study Group (2008) Excess mortality due to interaction between protein energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transpl 23(9):2957–2964CrossRefGoogle Scholar
  23. 23.
    Sasai H, Brychta RJ, Wood RP, Rothney MP, Zhao X, Skarulis MC, Chen KY (2015) Does visceral fat estimated by dual-energy X-ray absorptiometry independently predict cardiometabolic risks in adults? J Diabetes Sci Technol 9(4):917–924CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sherman A, Hootkins R, Nissensson AR, Fine RN (2008) Simplified formula and normograms for monitoring hemodialysis adequacy. In: Handbook of dialysis therapy, 4th edn. Saunders Elsevier, Philadelphia, pp 310–318CrossRefGoogle Scholar
  25. 25.
    Bikbov BT, Tomilina NA (2004) Letters and replies: some notes about the usage of the charlson comorbidity index. Nephrol Dial Transpl 19(11):2926–2927CrossRefGoogle Scholar
  26. 26.
    Gohda T, Gotoh H, Tanimoto M, Sato M, Io H, Kaneko K (2008) Relationship between abdominal fat accumulation and insulin resistance in hemodialysis patients. Hypertens Res 31:83–88CrossRefPubMedGoogle Scholar
  27. 27.
    Kaysen GA, Kotanko P, Zhu F, Sarkar SR, Heymsfield SB, Kuhlmann MK (2009) Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients. J Ren Nutr 19:357–364CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kato A, Ishida J, Endo Y, Takita T, Furuhashi M, Maruyama Y (2010) Association of abdominal visceral adiposity and thigh sarcopenia with changes of arteriosclerosis in hemodialysis patients. Nephrol Dial Transpl 26(6):1967–1976CrossRefGoogle Scholar
  29. 29.
    Sanches FM, Avesani CM, Kamimura MA, Lemos MM, Axelsson J, Vasselai P (2008) Waist circumference and visceral fat in CKD: a cross-sectional study. Am J Kidney Dis 52:66–73CrossRefPubMedGoogle Scholar
  30. 30.
    Webb DA, Robbins JM, Bloch JR, Culhane JF (2010) Estimating prevalence of overweight and obesity at the neighborhood level: the value of maternal height and weight data available on birth certificate records. Popul Health Metr 8(1):16CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mannucci E, Petroni ML, Villanova N et al (2010) Clinical and psychological correlates of health-related quality of life in obese patients. Health Qual Life Outcomes 8:90CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A, AlkaMeSy Study G (2010) Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 33(4):920–922CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Elsayed EF, Sarnak MJ, Tighiouart H (2008) Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis 52:29–38CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Abolfotouh MA, Soliman LA, Mansour E, Farghaly M, El-Dawaiaty AA (2008) Central obesity among adults in Egypt: prevalence and associated morbidity. East Mediterr Health J 14(1):57–68PubMedGoogle Scholar
  35. 35.
    Postorino M, Marino C, Tripepi G (2009) Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol 53:1265–1272CrossRefPubMedGoogle Scholar
  36. 36.
    Chen H-Y, Chiu Y-L, Chuang Y-F, Hsu S-P, Pai M-F, Yang J-Y, Peng Y-S (2014) Visceral adiposity index and risks of cardiovascular events and mortality in prevalent hemodialysis patients. Cardiovasc Diabetol 13(1):136CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N (2012) Central obesity and comorbidity risk in hemodialysis patients: a cross sectional study in Lebanon. Open J Nephrol 2:109–115CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Departments of Nephrology and Radio-DiagnosisAin Shams UniversityAbbassia, CairoEgypt

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