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


CONCLUSIONS
Ci, WHR, and VAI are cheap alternatives for accurate assessment of morbidity and mortality risk in centrally obese prevalent HD patients.
Departments of Nephrology and Radio-Diagnosis, Ain Shams University, Abbassia, Cairo, 11351, Egypt. h.elsaid@med.asu.edu.eg.
Heba Wahid
http://orcid.org/0000-0002-2328-2368
HW
El Said
Departments of Nephrology and Radio-Diagnosis, Ain Shams University, Abbassia, Cairo, 11351, Egypt.
Osama Mahmoud
OM
Mohamed
Departments of Nephrology and Radio-Diagnosis, Ain Shams University, Abbassia, Cairo, 11351, Egypt.
Tamer Wahid
TW
El Said
Departments of Nephrology and Radio-Diagnosis, Ain Shams University, Abbassia, Cairo, 11351, Egypt.
Ahmed Bahaa
AB
El Serwi
D000328:Adult; D000368:Aged; D001827:Body Height; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D050507:Subcutaneous Fat, Abdominal / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055105:Waist Circumference; D049629:Waist-Hip Ratio
Central obesity; Hemodialysis; Morbidity