Endocrine Abstracts

Aim: Epicardial adipose tissue (EAT) has important physiologic functions, nonetheless, excessive EAT leads to a proinflammatory state with adverse effects on the myocardium. EAT has also been associated with adverse outcomes in chronic kidney disease (CKD) patients. We think that visceral adipose tissue (VAT) and organ-specific ectopic fat plays an important role in cardiorenal dysfunction. The aim of our study is to analyse the relationship between EAT and the risk of developing albuminuria.

Methods: We reviewed the records of subjects who underwent a routine health check-up, had a computed tomography whole body scan and blood test in the same visit at our Center from July 1, 2003 to December 31, 2006 and had at least one follow-up control (181 patients were included in the analysis). EAT was quantified semiautomatically including voxels with attenuation values between -45 to -190 HU. EAT was adjusted for body surface area (EATi; normal limit: 68.1 cm³/m²). The outcome was defined as the presence of albuminuria at follow-up. Micro-albuminuria and macro-albuminuria were defined as urinary albumin-creatinine ratio (UACR) >30 mg/gCr and >300 mg/gCr in spot urines, respectively.

Results: Mean age was 55.9±8.5 years (76.8% were men). Seventy-seven (43%) subjects had normal EATi and 104 (57%) an abnormal EATi. Patients with abnormal EATi were predominantly men, older and had a higher glycemia, HOMA-IR, a more detrimental lipid profile, hyperuricemia, worse liver function (P<0.05), a higher prevalence of metabolic syndrome disorders, higher indices of adiposity and higher CAC Score. We observed a 36.5% (95% CI: 20.2-52.8), 54.3% (95% CI: 42.7-65.8) and 85.3% (95% CI: 73.0-97.6) of subjects with abnormal EATi in each tertile of VAT, respectively. The proportion of subjects with abnormal EATi was significantly higher at the third tertile of VAT compared with the first tertile (diff: 49% 95% CI: 25% - 72%) (P<0.01). After a median follow up of 11.22 years (25th percentile: 4.7; 75th percentile: 14.9), 32 events of albuminuria were registered. Mean (sd) albuminuria of those subjects was 242 mg/gCr (769.13). Patients with high levels of EATi had an increased risk of albuminuria after adjustment for age, sex, BMI, diabetes and antiplatelet therapy, medical treatment for diabetes, dyslipidemia, hypertension, or hyperuricemia at baseline using the IPW method: HR (95% CI) 4.05 (1.19-13.82) (P=0.025).

Conclusions: EAT is associated with renal dysfunction assessed through urinary albumin-creatinine ratio. Our results, endorse the term Obesity-related Adipose tissue Disease (OrAD) to collectively englobe the diverse pathologies related to adiposopathy.