mrs. watcharasa pitug id. 567110011-2 the association between waist circumference and renal...
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Mrs. Watcharasa Pitug
ID. 567110011-2
The Association between Waist Circumference and Renal Insufficiency
among Hypertensive Patients
200423/ /1
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)
200423/ /3
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
200423/ /4
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)
200423/ /5
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
200423/ /6
Gab of knowledge
200423/ /7
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.
200423/ /8
Objective
To investigate the association between waist circumference and Renal insufficiency among hypertensive patients
200423/ /9
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
200423/ /12
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
200423/ /13
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
200423/ /18
Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor
200423/ /19
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)
200423/ /20
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)
200423/ /21
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
200423/ /25
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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