The Association between Waist Circumference and Renal Insufficiency among Hypertensive Patients

1. The Association between Waist Circumference and Renal Insufficiency among Hypertensive Patients Mrs. Watcharasa Pitug ID. 567110011-2

2. Contents • Background/Rationale • Objective • Methods • Results • Discussion &Conclusions

3. 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)

4. 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

5. 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 (ThaweeSiriwong, 2007) In 2008 : Chronic Renal Insufficiency patients in Thailand 17.5% (สมาคมโรคไตแห่งประเทศไทย, 2008)

6. Clinical complications of renal failure Loss of erythropoietin –anaemia Parathyroid gland disturbances –renal bone disease Myocardial fibrosis and cardiomyopathy Active vitamin D deficiency Immunodeficiency Atherosclerosis and arteriosclerosis Malnutrition/wasting ..and many others Polyneuropathy No diuresis –overhydration

7. Gab of knowledge • The relationship of obesity to Renal insufficiency is somewhat controversial. While it is established that obesity increases the risk of hypertension, diabetes and dyslipidemia • it is not clear if excess waist circumference influences Renal insufficiency independently Correlation 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

8. Objective • To investigate the association between waist circumference and Renal insufficiency among hypertensive patients 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.

9. Methods The inclusion flow chart Sampling frame DM, HT & DMHT N=61,706 Exclude DM & DMHT (n=28,938) Sample only HT patients (n=32,768) Exclude if not estimate waist circumference (n=23,287) Study participants (n=9,481)

10. Methods Modification of Diet in Renal Disease (MDRD) in Thailand Go AS et., 2004

11. Methods Variables and measurements

12. Methods Variables and measurements

13. Methods Statistic Analysis • 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).

14. Results Basic characteristic of the individual included in the study

15. Results Basic characteristic of the individual included in the study

16. Results Basic characteristic of the individual included in the study

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

18. 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)

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)

20. Forest plotwas 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

21. Discussion & Conclusions 1 2 1 2

22. Discussion & Conclusions

23. Discussion & Conclusions

24. 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.

25. Thanks for your attention