Associações entre obesidade abdominal e ritmo de filtração glomerular e albuminúria em pacientes hipertensos e não diabéticos

• Ano de defesa: 2020
• Autor(a) principal: Lobo, Sylvia Madeira De Vergueiro [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Albuminuria; Central Obesity; Obesity; Hypertension; Insulin Resistence; Obesidade; Hipertensão; Resistência A Insulina
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9968501; https://hdl.handle.net/11600/64759

Obesity, a condition that has reached epidemic proportions in our century, is recognized as a risk factor for chronic kidney disease (CKD). However, it has not yet been completely clarified whether this association would be dependent on metabolic changes related to insulin resistance or if it could be also a consequence of visceral fat accumulation that, by mechanical compression, would lead to renal hemodynamic changes and increased albuminuria. The objective of our study was to evaluate, in a cohort of non-diabetic hypertensive patients, the association between anthropometric measures of obesity, such as body mass index (BMI) and waist circumference (WC), with the values of urinary albumin and creatinine ratio (UACR), as well as its relationship with metabolic factors related to insulin resistance. A total of 309 participants were included and stratified according to gender and the median of WC (98.5 cm in men and 94.0 cm in women). We observed an association between higher WC and higher UACR, both in men (5.6 [2.7-10.3] vs 8.2 [5.4-22.0] mg/g; p= 0.011) and in women (4.3 [3.0-7.6] vs 6.1 [3.9 -9.0] mg/g; p= 0.005). In a model with log UACR as the dependent variable, the independent variables tested, including WC, male gender, systolic blood pressure (SBP) and the ratio between serum triglycerides and HDL-cholesterol levels (logTG / HDL), taken as an index of insulin resistance, were all predictors of UACR, explaining 9.3% of its variance. However, in another multivariate linear regression model, when WC was replaced by BMI, male gender, SBP and logTG / HDL, but not BMI, remained as independent predictors of UACR. Conclusion: Excess of abdominal fat but not increased BMI, is associated with increases in urinary albumin excretion. Our results suggest that, although metabolic alterations and blood pressure may have a deleterious influence on albuminuria, abdominal fat accumulation may itself directly contribute to renal injury.