The assessment of risk factors associated with epicardial fat tissue thickness in stage 4 and 5 chronic kidney disease patients

ABSTRACT Introduction: Epicardial adipose tissue (EFT) is a visceral fat tissue compartment surrounding the heart, located between myocardium and visceral pericardium. Visceral fat is known to be associated with cardiovascular risk factors such as insulin resistance, atherosclerosis and inflammation in chronic kidney disease (CKD). Therefore, EFT may be one of the cardiovascular risk factors in CKD patients. In this study, it was aimed to evaluate the risk factors associated with EFT, which is a sign of visceral adipocyte in patients with stage 4 and 5 CKD diagnosis and who did not undergo renal replacement therapy. Materials and methods: This study included 80 patients with Stage 4 and Stage 5 CKD who were not previously treated with renal replacement therapy at the nephrology clinic of the Dicle University Medical Faculty Hospital or nephrology policlinic for various reasons. Exclusion criterias were; cardiac insufficiency (EF<50%), age<18 years and >80 years, presence of hemodynamic instability, pregnancy, pacemaker use, presence of amputated extremity, receiving dialysis treatment, history of ischemic heart disease, obesity [Body mass index (BMİ) >35], malignancy, cerebrovascular event history. The BMI, urine volume, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the patients were measured. The bioimpedance analysis (BİA) was performed to determine body composition. In this analysis, body fat tissue mass (FTM), fat tissue index (FTI), adipose tissue mass (ATM), lean tissue mass (LTM), lean tissue index (LTI) was performed. Echocardiographic (ECHO) examination of patients was performed to measure EFT thickness. Findings: Twenty six of the patients included in the study had Stage 4 CKD and 54 had Stage 5 CKD. Fourty two of the patients were male (52%) and 38 were female (48%). The mean age of the patients was 52.91±16.37 and the mean BMI was 24.13±14.44 kg/m2. The mean SBP of the patients was 132,94±17,31 mmHg, mean DBP was 81,01±11,83 mmHg, mean FTM was 18,92±7,73 kg, mean FTI was 9,58±4,41 kg/m2, mean LTM was 42,27±11,83 kg, mean LTI was 15,10±3,82 kg/m2, mean EFT was 6,4±1.21 mm. The mean EFT thickness in stage 5 CKD patients was significantly higher than in stage 4 CKD patients (6.7±1.2mm vs 5.9±0.9mm, p=0.003). EFT showed a negative correlation with HDL and albumin, whereas positively with BMI, SBP, DBP, c-reaktive protein (CRP), age, triglyceride, FTM and FTI (p<0.05). In multi step linear regression analysis, increased SBP, increased BMI, low albumin level and low HDL levels were independently associated with increased EFT thickness (p<0.05). Conclusion: We believe that it may be useful to measure the thickness of the EFT as a predictor of cardiovascular risk in CKD by using practical methods such as ECHO, and also that correcting the factors that increase the EFT thickness may lead to positive results. Keywords: Chronic kidney disease, Epicardial fat tissue thickness, bioimpedance analysis