Abstract
ObjectiveWe try to analyse the effect of renal functions on death in CAD patients with different body compositions.MethodsA retrospective analysis was conducted in 2989 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into two categories: basically preserved renal function (PRF) (eGFR ≥60 ml/min) and obviously reduced renal function (RRF) (eGFR <60 ml/min). The influence of renal insufficiency on mortality of CAD was detected in every tertile of body composition, including body mass index (BMI), body fat (BF) and lean mass index (LMI). The end points were all-cause mortality.ResultsThe mean follow-up time was 29.1 ± 12.5 months and death events occurred in 271 cases. The percentage of patients with RRF was positively correlated with BF and inversely correlated with the LMI, but no relationship to BMI. The survival curves showed that the risk of death was significantly higher in the RRF patients in all subgroups stratified using BMI, BF, or LMI (log rank test, all p < 0.001). The COX multivariate regression analysis showed that the risk of death was significantly higher in the RRF patients with high BF (HR 1.95, CI 1.25–3.05) and low LMI (HR 1.82, CI 1.19–2.79). Meanwhile, risk of death was significantly higher in RRF patients with a high BMI (HR 2.08, CI 1.22–3.55) or low BMI (HR 1.98, CI 1.28–3.08) but this risk was not significant in patients with a medium BMI (HR 1.12, 0.65–1.94). The subgroup analysis of patients with acute coronary syndrome (ACS) showed similar results.ConclusionsFor patients with CAD, renal insufficiency was positively correlated with BF, inversely correlated with LMI, and unrelated to BMI. The effect of renal insufficiency on the risk of death of CAD was related to body composition.
Highlights
Obesity is becoming one of the most important global health problems
Significant differences were observed in the clinical characteristics between groups, with more severe renal insufficiency associated with an older age, female gender, and comorbidities such as hypertension, diabetes, cardiac dysfunction, and complex coronary artery disease (CAD)
The COX multivariate regression analysis showed that the risk of death was significantly higher in the reduced renal function (RRF) patients with high body fat (BF) (BF tertile 3) (HR 1.95, confidence interval (CI) 1.25–3.05) and low lean mass index (LMI) (LMI tertile 1) (HR 1.82, CI 1.19–2.79), whereas the risk of RRF for death was not significant in patients with low BF (BF tertile 1) (HR 1.64 0.92–2.93) and high LMI (LMI tertile 3) (HR 1.71, CI 0.91–3.20) after multivariable correction (Table 2)
Summary
Obesity is becoming one of the most important global health problems. According to the World Health Organization (WHO) survey in 2008, approximately 35 % of adults over the age of 20 were overweight worldwide, accounting for % of men and % of women in thisPeng et al Cardiovasc Diabetol (2016) 15:1067]. Researchers have conducted numerous studies on the relationship between obesity and the outcome of CAD but have reached different conclusions. Researchers have proposed the theory of the “obesity paradox” [8, 9], and studies have shown that the obesity paradox applies to chronic kidney disease in addition to CAD [10, 11]. Few studies have been conducted to investigate the effect of renal insufficiency on the outcome of coronary artery disease in patients with different body compositions. We evaluated body fat with body composition-related parameters, such as the body mass index (BMI), body fat (BF), and lean mass index (LMI), and analysed the effect of renal functions on death in CAD patients with different body compositions
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