Mrs. Watcharasa Pitug

ID. 567110011-2

The Association between Waist Circumference and Renal Insufficiency

among Hypertensive Patients

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Contents

Background/RationaleObjectiveMethodsResultsDiscussion &Conclusions

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Background/Rationale

Chronic kidney disease (CKD) has become a global public health problem and is a common

condition in the United States(Alejandro et al.,2009 ; Essam et al.,2008 ; Adam

et al., 2007) In 2004, there were approximately 472,000

patients with treated ESRD (Alejandro et al.,2009 )

By 2030, expected to increase to more than 2 million. The estimated prevalence of earlier CKD stages (stages 1 through 4) in US adults was 24

to 28 million based on the 2000 (Adam et al., 2007)

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Chronic kidney disease: classification and clinical consequences

Relative risk of death in relation to kidney function(N=1,120,295 pts) CKD -KDOQI classification

Go AS et., 2004

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Modification of Diet in Renal Disease (MDRD) in Thailand

In 2007 : Chronic Renal Insufficiency patients 13.2% in state 3 and 0.61% in state 4

(Thawee Siriwong, 2007)

In 2008 : Chronic Renal Insufficiency patients in Thailand 17.5% (สมาคมโรคไตแห่�งประเทศไทย, 2008)

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Clinical complications of renal failure

Parathyroid gland

disturbances –renal bone

diseaseActive vitamin D deficiency

Atherosclerosis

and arterioscleros

isPolyneuropathy

No diuresis –overhydration

..and many others

Malnutrition/wasting

Immunodeficiency

Myocardial fibrosis and

cardiomyopathy

Loss of erythropoietin –

anaemia

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Gab of knowledge

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The relationship of obesity to Renal insufficiency is somewhat controversial.

While it is established that obesity increases the risk of hypertension, diabetes and

dyslipidemiait is not clear if excess waist

circumference influences Renal insufficiency

independentlyCorrelation between waist circumference and (A) visceral and (B) subcutaneous fat areas assessed by using computed

tomography in 75 men (open circle; dotted lines) and 47 women (filled triangle; solid lines) with prevalent chronic

kidney disease.

Fabiana et al.,2008

Methods

Analytic study was conducted all information were collected from medical records of all patients diagnosed with Hypertension during 2012. The type of hypertension complications was based on Renal insufficiency was the main outcome of this study.

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Objective

To investigate the association between waist circumference and Renal insufficiency among hypertensive patients

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The inclusion flow chartSampling

frameDM, HT &

DMHTN=61,706Sample only HT patients

(n=32,768)

Study participants (n=9,481)

Exclude DM & DMHT

(n=28,938)

Exclude if not estimate waist circumference(n=23,287)

Methods

Modification of Diet in Renal Disease (MDRD) in Thailand

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Methods

Go AS et., 2004

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Methods

Variables and measurements

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variables Outcome measurements

Co-variatedCholesterol(mg/dl) 0= Chol < 170 , 1= Chol >=170

Triglyceride(mg/dl) 0=TG <150 , 1= TG >=150

HDL(mg/dl) 0= HDL male >=40; HDL female >=50 1= HDL male <40; HDL female <50

LDL(mg/dl) 0= LDL <100 , 1= LDL >=100

Hemoglobin (g/dl) normal (male HGB ≥14; female HGB≥12)low (male HGB <14; female HGB<12)

Hematocrit normal (male HCT ≥42; female HCT≥37)

low (male HCT <42; female HCT<37)

Variables and measurements

Methods

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Demographic characteristics were described using frequency and percentage for categorical data such as gender, age group,WC group, BMI group, Cigarette smoking use, fasting plasma glucose group, total cholesterol group, triglyceride group, HDL cholesterol group, LDL cholesterol group, hemoglobin group and hematocrit group.

Using mean, standard deviation, median, minimum, and maximum to described continuous data such as age, BMI, fasting plasma glucose level, total cholesterol level, triglyceride level, HDL cholesterol level, LDL cholesterol level, hemoglobin level and hematocrit level.

To investigate factors that associated with chronic renal insufficiency, adjusted odds ratios (ORs) and their 95% confidence intervals (95%CIs) were estimated using multiple logistic regression.

All test statistics were p-value of less than 0.05 was considered statistical significant.

All analyses were performed by using STATA version 12.0 (AtataCorp, College Station, TX).

Statistic AnalysisMethods

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ResultsBasic characteristic of the individual

included in the study

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Results

Basic characteristic of the individual included in the study

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Results

Basic characteristic of the individual included in the study

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Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor

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Odds ratios (ORs) of having Renal Insufficiency and their 95% confidence intervals for each factor adjusted for all other factors presented in the table using logistic regression (n=13151)

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Odds ratios (ORs) of having Renal Insufficiency and their 95% confidence intervals for each factor adjusted for all other factors presented in the table using logistic regression (n=13151)

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Forest plot was compare for each factors affecting chronic renal insufficiency, presented as odds ratio adjusted for waist circumference, age, gender, BMI, smoking, triglyceride, and Hemoglobin, using multiple logistic regression

Discussion & Conclusions

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Discussion & Conclusions

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Discussion & Conclusions

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Discussion & Conclusions

In summary, in agreement with the findings in the general population, the present study shows that WC is not associated with Chronic Renal Insufficiency in

individuals. In previous study, associations found between WC and some CVD risk factors were similar to those observed for visceral fat, suggesting that WC is a simple and economic tool to be used more often in epidemiological research also involving patients

with CKD. Prospective studies are necessary to evaluate the reproducibility of WC and the ability of

this method to predict outcomes in patients with CKD.

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