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Impact of metabolic and inflammatory changes on glomerular function beyond conventional risk factors in an urban South Africa community with prevalent obesity
- Source :
- Cardiovascular Journal of Africa. 31:39-50
- Publication Year :
- 2020
- Publisher :
- Clinics Cardive Publishing, 2020.
-
Abstract
- OBJECTIVES To determine the extent to which metabolic and inflammatory changes are associated with renal damage beyond conventional risk factors in a community sample with a high prevalence of obesity in urban South Africa. METHODS This was a cross-sectional, community-based study in 1 010 (n = 872 without diabetes mellitus, DM) randomly selected participants over 16 years of age in an urban, developing community (Soweto, Johannesburg) with a high prevalence of obesity (41.8%). We assessed estimated glomerular filtration rate (eGFR), conventional risk factors including adiposity indices, and metabolic changes and plasma resistin concentrations (ELISA) and the homeostasis model of insulin resistance (HOMA-IR). Relationships independent of haemodynamic loads were confirmed using ambulatory blood pressure and central arterial haemodynamics. RESULTS In multivariate regression models conducted in those without DM, HOMA-IR (standardised β-coefficient = -0.13 ± 0.03, p < 0.0001) and plasma resistin concentrations (β-coefficient = -0.10 ± 0.02, p < 0.0001) were second only to age, and at least as strong as systolic blood pressure (β -coefficient = -0.04 ± 0.03, p = 0.19) in the impact on eGFR, while alternative conventional risk factors including adiposity indices and the metabolic syndrome features contributed little to eGFR. Similar results were obtained in relationships with chronic kidney disease (CKD) and in the whole group including those with DM. Adjustments for ambulatory blood pressure or central arterial loads did not influence these relationships. CONCLUSIONS The impact on glomerular function of insulin resistance and inflammatory changes is well beyond modifiable conventional risk factors, including the metabolic syndrome. Targeting conventional risk factors alone is likely to result in a marked residual risk of renal damage produced by insulin resistance and inflammation.
- Subjects :
- Adult
Blood Glucose
Male
Ambulatory blood pressure
Kidney Glomerulus
Physiology
Renal function
Blood Pressure
Risk Assessment
South Africa
Insulin resistance
Risk Factors
Diabetes mellitus
Prevalence
medicine
Humans
Insulin
Resistin
Obesity
Renal Insufficiency, Chronic
Adiposity
Inflammation
business.industry
General Medicine
Middle Aged
Prognosis
medicine.disease
Cross-Sectional Studies
Blood pressure
Female
Inflammation Mediators
Insulin Resistance
Metabolic syndrome
Cardiology and Cardiovascular Medicine
business
Biomarkers
Glomerular Filtration Rate
Kidney disease
Subjects
Details
- ISSN :
- 16800745 and 19951892
- Volume :
- 31
- Database :
- OpenAIRE
- Journal :
- Cardiovascular Journal of Africa
- Accession number :
- edsair.doi.dedup.....e61e613adad465e3397c0fdaf71fbed5
- Full Text :
- https://doi.org/10.5830/cvja-2019-057