Assesment of risk factors associated with epicardial adipose tissue thickness in dialysis patients

ABSTRACT Assesment of risk factors associated with epicardial adipose tissue thickness in dialysis patients Introduction Epicardial adipose tissue is, a visceral fat tissue compertment between myocardium and visceral pericardium, surronding the heart. Epicardial Fat Tissue (EFT) has begun to used as a strong marker for cardiovascular risk in community. EFT acts as a source for inflammatory adipocytokines. Because of the absence of any barrier between the inflamed EFT and the coronary arteries, atherosclerotic changes are caused by direct paracrin effects. Epicardial fat tissue is thought to be one of the effective factors on cardiovascular disease (CVD) risk in patients undergoing dialysis. In this study, we aimed to asses the risk factors associated with EFT in patients with end stage renal disease (ESRD) undergoing dialysis treatment. Meterial and Method Patients, diagnosed as ESRD and udergoing one of the dialysis programme at least for six months, admitted to Dicle University Medical Faculty Hospital Nephrology Department dialysis unit between January 2016 and December 2016 included in this study. Patients; aged <18 years, > 80 years old, obesity (Body Mass Index (BMI)>35), history of heart failure (EF<%50), ischemic heart disease, malignancy, cerebrovascular event were excluded. Patients' BMI were calculated by measuring height and weight, also waist circumfarence was measured. Patients' mean arterial pressure (MAP) was determined by measuring systolic and diastolic blood pressure. Patients' residual urine volume and dialysis duration were noted. Bioimpedance analysis was performed after dialysis programme to determine the body composition of the patients. In this analysis fat tissue mass (FTM), fat tissue mass percent, adipose tissue mass (ATM), lean tissue mass (LTM), lean tissue mass percent, fat tissue index (FTI), lean tissue index (LTI), total body water (TBW), extracellular water (ECW), intracellular water (ICW), over hidration (OH) were assessed. EFT was measured by echocardiographic examination. Results 83 ESRD patients (62 hemodialysis (HD), 21 Continious Ambulatory Peritoneal Dialysis (CAPD)) who underwent dialysis treatment were included in the study. 49 of the patients were female (59%) and 34 were male (41%). The mean age of the patients was 46,09±17,17. The mean Mean Arterial Pressure was 106,09±100,21 mmHg, mean duration of dialysis was 70,01±51,19 months, mean FTM was 18,89±11,23 kg, mean LTM was 33,85±11,54 kg, mean EF (%) 60,1±5,34, and mean EFT thickness was 4.99±1,68 mm. The mean EFT thickness was significantly higher in the HD patient group than in the CAPD patient group (p<0.05). There was a positive correlation found between EFT and age, BMI, waist circumfrance, end systolic and diastolic inter ventricular septum thickness (IVST), FTM, FTM percent, ATM, FTI, VLDL and CRP while a negatif correlation was found between EFT and LTM, LTM percent and OH. Conclusion It may be useful to measure EFT with practical and non-invasive methods in chronic kidney disease (CKD) patients known to be highly affected from cardiovascular disease. We think that measurement of EFT thickness by ecocardiography provide important information about cardiovascular mortality in these patients. We suggest that correcting factors that increase the EFT thickness in dialysis patients may lead to positive results. Key words: Hemodialysis, Peritoneal dialysis, Epicardial fat tissue