Metabolic syndrome and abdominal fat are associated with inflammation, but not with clinical outcomes, in peritoneal dialysis patients
1 Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
2 Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
3 Integrated Diagnostics and Therapeutics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
4 Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
5 National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan
6 National Taiwan University College of Medicine and Hospital, Hsin-Chu Branch, Hsin Chu City, Taiwan
7 Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan
8 Cardiovascular Center & Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Cardiovascular Diabetology 2013, 12:86 doi:10.1186/1475-2840-12-86Published: 8 June 2013
In the general population, metabolic syndrome (MetS) is correlated with visceral fat and a risk factor for cardiovascular disease (CVD); however, little is known about the significance of abdominal fat and its association with inflammation and medication use in peritoneal dialysis (PD) patients. We investigated the relationship of visceral fat area (VFA) with C-reactive protein (CRP) levels and medication use in PD patients and followed their clinical outcomes.
In a prospective study from February 2009 to February 2012, we assessed diabetes mellitus (DM) status, clinical and PD-associated characteristics, medication use, CRP levels, components of MetS, and VFA in 183 PD patients. These patients were categorized into 3 groups based on MetS and DM status: non-MetS (group 1, n = 73), MetS (group 2, n = 65), and DM (group 3, n = 45). VFA was evaluated by computed tomography (CT) and corrected for body mass index (BMI).
Patients in group 1 had smaller VFAs than patients in groups 2 and 3 (3.2 ± 1.8, 4.6 ± 1.9, and 4.9 ± 2.0 cm2/[kg/m2], respectively, P < 0.05) and lower CRP levels (0.97 ± 2.31, 1.27 ± 2.57, and 1.11 ± 1.35 mg/dL, respectively, P < 0.05). VFA increased with the number of criteria met for MetS. After adjusting for age, body weight, and sex, CRP and albumin levels functioned as independent positive predictors of VFA; on other hand, the use of renin-angiotensin system blockers was inversely correlated with VFA in PD patients without DM. In the survival analysis, DM patients (group 3) had the poorest survival among the 3 groups, but no significant differences were found between groups 1 and 2.
This study showed that VFA and MetS are associated with CRP levels but cannot predict survival in PD patients without DM. The complex relationship of nutritional parameters to VFA and MetS may explain these results. The type of antihypertensive medication used was also associated with the VFA. The mechanisms behind these findings warrant further investigation.