Obesity and chronic kidney disease progression-the role of a new adipocytokine: C1q/tumour necrosis factor-related protein-1
Obesity and chronic kidney disease progression-the role of a new adipocytokine: C1q/tumour necrosis factor-related protein-1
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DOI：
10.1093/ckj/sfy095
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发表时间：
2019-06-01
影响因子：
4.6
通讯作者：
Luno, Jose
中科院分区：
文献类型：
--
作者：
Barbieri, Diego;Goicoechea, Marian;Luno, Jose
背景肥胖是普通人群中慢性肾脏病（CKD）的一个危险因素。C1 q/肿瘤坏死因子相关蛋白1（CTRP 1）是一种新的脂肪因子，具有多种血管和代谢作用，可能调节肥胖与血管疾病之间的关系。该研究的目的是探索肥胖、CTRP 1水平和CKD进展之间的潜在联系。入选了3期和4期CKD患者，既往无心血管事件，并根据体重指数（BMI）分为两组。在基线时收集人口统计学、临床和分析数据以及CTRP 1水平。在随访期间，记录肾脏事件[定义为开始透析、血清肌酐加倍或估计肾小球滤过率下降50%（肾脏疾病饮食调整）]。共71例CKD患者分为两组：25例肥胖（BMI >30 kg/m2）和46例非肥胖。肥胖患者基线时血浆CTRP 1水平较高[中位数（四分位距）360（148）vs 288（188）ng/mL，P = 0.041]。CTRP 1水平与CKD分期、糖尿病、醛固酮和肾素水平或血压之间无显著相关性。肥胖患者的收缩压（P = 0.018）、高敏C反应蛋白（P = 0.019）和尿酸（P = 0.003）水平较高，但糖尿病患者百分比和白蛋白尿无显著差异。在平均65个月的随访期间，14例患者发生了肾脏事件。最低三分位数中CTRP 1的患者发生更多肾脏事件，无论是在总体样本中（对数秩：5.810，P = 0.016）还是在肥胖患者中（对数秩：5.405，P = 0.020）。在校正了肥胖、阿司匹林、蛋白尿和肾功能的模型中，较高的CTRP 1水平与较慢的肾脏进展相关（风险比0.992，95%置信区间0.986-0.998; P = 0.001）。肥胖CKD患者的CTRP 1水平高于非肥胖CKD患者。高CTRP 1水平可能具有肾脏保护作用，因为它们与肾脏疾病进展缓慢相关。需要进行干预性研究来探讨这一假设。
Background. Obesity is a risk factor for incident chronic kidney disease (CKD) in the general population. C1q/tumour necrosis factor-related protein 1 (CTRP1) is a new adipokine with multiple vascular and metabolic effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP1 levels and CKD progression.Methods. Patients with Stages 3 and 4 CKD without previous cardiovascular events were enrolled and divided into two groups according to body mass index (BMI). Demographic, clinical and analytical data and CTRP1 levels were collected at baseline. During follow-up, renal events [defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate (Modification of Diet in Renal Disease)] were registered.Results. A total of 71 patients with CKD were divided into two groups: 25 obese (BMI >30 kg/m(2)) and 46 non-obese. CTRP1 in plasma at baseline was higher in obese patients [median (interquartile range) 360 (148) versus 288 (188) ng/mL, P = 0.041]. No significant association was found between CTRP1 levels and CKD stage, presence of diabetes, aldosterone and renin levels, or blood pressure. Obese patients had higher systolic blood pressure (P = 0.018) and higher high-sensitivity C-reactive protein (P = 0.019) and uric acid (P = 0.003) levels, without significant differences in the percentage of diabetic patients or albuminuria. During a mean follow-up of 65 months, 14 patients had a renal event. Patients with CTRP1 in the lowest tertile had more renal events, both in the overall sample (log rank: 5.810, P = 0.016) and among obese patients (log rank: 5.405, P = 0.020). Higher CTRP1 levels were associated with slower renal progression (hazard ratio 0.992, 95% confidence interval 0.986-0.998; P = 0.001) in a model adjusted for obesity, aspirin, albuminuria and renal function.Conclusions. CTRP1 levels are higher in obese than in non-obese patients with CKD. High CTRP1 levels may have a renal protective role since they were associated with slower kidney disease progression. Interventional studies are needed to explore this hypothesis.