Abstract: TH-OR26
Nutritional Status and Cardiorenal Syndrome: Associations of Protein-Energy Wasting and Abdominal Obesity With the Risk of Heart Failure in CKD
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, Prevention
November 03, 2022 | Location: W240, Orange County Convention Center‚ West Building
Abstract Time: 05:06 PM - 05:15 PM
Category: Hypertension and CVD
- 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention
Authors
- Agarwal, Tejita, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Moghaddam, Farahnaz Akrami, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Sammons, Stephen R., The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Sarwal, Amara, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Agarwal, Adhish, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background
The term malnutrition is defined as faulty nutrition due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization. In that context, both Protein-Energy Wasting (PEW) syndrome and abdominal obesity are two extremes of this disorder. We examined the hypothesis that both of these extremes are risk factors for heart failure (HF) in CKD and thus might play a role in cardiorenal syndrome.
Methods
We used data from the Chronic Renal Insufficiency Cohort Study (CRIC), a NIH-funded observational study of participants with CKD. We used a previously published, modified definition of PEW syndrome categories (low serum chemistry, low body mass and low muscle mass). Presence of at least one criteria (albumin <3.5 g/dl or cholesterol <100 mg/dl for serum chemistry, BMI < 23 kg/m2 for body mass and sex specific <25th percentile of 24-hour urinary creatinine for low muscle mass) within each category was considered to meet the presence of that category. Abdominal obesity was defined by waist circumference. We used separate Cox regression models to relate baseline PEW and abdominal obesity with the time to subsequent adjudicated HF outcomes.
Results
3745 CRIC participants were included. Mean baseline age was 58 ± 11 yrs and eGFR 44 ± 15 ml/min/1.73 m2. At baseline, 1094 patients (29.2%) met 1 PEW criterion, 320 (8.5%) met ≥ 2 criteria and 2486 (67%) had abdominal obesity. There were 630 HF events over 32,877 years of follow-up. As shown in table, adjusted for baseline demographics, smoking, alcohol use, income, comorbid conditions, BP levels, and eGFR, both PEW and abdominal obesity were associated with higher risk of HF events.
Conclusion
Abdominal obesity is much more common than PEW in CKD. Both abdominal obesity and PEW are risk factors for HF in CKD. The underlying mechanisms by which PEW might play a role in cardiorenal syndome needs further study.
HR (95% CI) for CHF
| Unadjusted | +Demographics, alcohol, smoking, income | +Comorbidities, BPs, eGFR | |
| Model 1 | |||
| 0 PEW criterion | Reference | Reference | Reference |
| 1 PEW criterion | 2.14 (1.81, 2.52) | 2.05 (1.74, 2.43) | 1.77 (1.49, 2.09) |
| ≥2 PEW criteria | 1.99 (1.52, 2.61) | 2.19 (1.67, 2.88) | 1.57 (1.18, 2.08) |
| Model 2 | |||
| Abdominal obesity | 1.68 (1.40, 2.01) | 1.66 (1.37, 2.00) | 1.34 (1.11, 1.63) |
Funding
- NIDDK Support