Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development
- 151 Downloads
Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk.
Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52–105).
Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23–1181) and for AVC was 0 (IQR 0–25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR −10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival.
EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.
KeywordsEpicardial adipose tissue Hemodialysis Coronary artery calcification Survival
Data were presented in part as an abstract at the ASN Renal Week congress 2014 in Philadelphia. The work performed by Xoana Barros at University Hospital of the RWTH Aachen was possible thanks to the Long-Term ERA-EDTA Fellowship Exchange Programme.
Compliance with the ethical standards
Conflict of interest
The authors declare they have no competing interests.
The study was approved by the ethical committee of the RWTH Aachen University Hospital.
Patients were included after written and informed consent.
- 3.Raggi P, Chertow GM, Torres PU, Csiky B, Naso A, Nossuli K, Moustafa M, Goodman WG, Lopez N, Downey G, Dehmel B, Floege J (2011) The ADVANCE study: a randomized study to evaluate the effects of cinacalcet plus low-dose vitamin D on vascular calcification in patients on hemodialysis. Nephrol Dial Transplant 26(4):1327–1339CrossRefPubMedGoogle Scholar
- 7.Mahabadi AA, Berg MH, Lehmann N, Kälsch H, Bauer M, Kara K, Dragano N, Moebus S, Jöckel K-H, Erbel R, Möhlenkamp S (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the heinz nixdorf recall study. J Am Coll Cardiol 61(13):1388–1395CrossRefPubMedGoogle Scholar
- 8.Kunita E, Yamamoto H, Kitagawa T, Ohashi N, Oka T, Utsunomiya H, Urabe Y, Tsushima H, Awai K, Budoff MJ, Kihara Y (2014) Prognostic value of coronary artery calcium and epicardial adipose tissue assessed by non-contrast cardiac computed tomography. Atherosclerosis 233(2):447–453CrossRefPubMedGoogle Scholar
- 11.Turkmen K, Kayikcioglu H, Ozbek O, Solak Y, Kayrak M, Samur C, Anil M, Zeki Tonbul H (2011) The relationship between epicardial adipose tissue and malnutrition, inflammation, atherosclerosis/calcification syndrome in ESRD patients. Clin J Am Soc Nephrol 6(8):1920–1925CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Brandenburg VM, Kramann R, Koos R, Kruger T, Schurgers L, Muhlenbruch G, Hubner S, Gladziwa U, Drechsler C, Ketteler M (2013) Relationship between sclerostin and cardiovascular calcification in hemodialysis patients: a cross-sectional study. BMC Nephrol 14:219CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Ulusal Okyay G, Okyay K, Polattas Solak E, Sahinarslan A, Pasaoglu O, Ayerden Ebinc F, Pasaoglu H, Boztepe Derici U, Sindel S, Arinsoy T (2015) Echocardiographic epicardial adipose tissue measurements provide information about cardiovascular risk in hemodialysis patients. Hemodial Int 19(3):452–462CrossRefPubMedGoogle Scholar
- 22.Nakazato R, Rajani R, Cheng VY, Shmilovich H, Nakanishi R, Otaki Y, Gransar H, Slomka PJ, Hayes SW, Thomson LE, Friedman JD, Wong ND, Shaw LJ, Budoff M, Rozanski A, Berman DS, Dey D (2012) Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography. Atherosclerosis 220(1):139–144CrossRefPubMedGoogle Scholar
- 23.Alexopoulos N, Melek BH, Arepalli CD, Hartlage GR, Chen Z, Kim S, Stillman AE, Raggi P (2013) Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). J Am Coll Cardiol 61(19):1956–1961CrossRefPubMedGoogle Scholar