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NDT Advance Access originally published online on June 17, 2009
Nephrology Dialysis Transplantation 2009 24(11):3474-3480; doi:10.1093/ndt/gfp290
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Contribution of subcutaneous fat accumulation to insulin resistance and atherosclerosis in haemodialysis patients

Hiromichi Gotoh1,2, Tomohito Gohda1, Mitsuo Tanimoto1, Yoshikazu Gotoh2, Satoshi Horikoshi1 and Yasuhiko Tomino1

1 Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine 2 Saiyu Souka Hospital, Japan

Correspondence and offprint requests to: Yasuhiko Tomino; E-mail: yasu{at}juntendo.ac.jp



  Abstract

Background. Whereas visceral fat accumulation (VFA) is related to insulin resistance and atherosclerosis in both haemodialysis (HD) patients and the general population, little is known about the role of subcutaneous fat accumulation (SFA). The purpose of the present study was to examine and confirm the relationship between abdominal fat accumulation (AFA) and various clinical parameters in HD patients.

Methods. Two hundred and thirty-three HD patients were recruited, including 120 with type 2 diabetes. Abdominal fat distribution was evaluated by computed tomography (CT) scans. Systemic atherosclerosis was assessed by intima–media thickness (IMT) using high-resolution B-mode ultrasonography. The insulin resistance was estimated by the homeostasis model assessment-insulin resistance (HOMA-IR).

Results. Spearman's analysis revealed that both VFA and SFA showed a significant relationship with HOMA-IR and also that SFA was correlated significantly with IMT in all HD patients. SFA was an independent risk factor associated with HOMA-IR and IMT in multiple regression analysis. Neither body mass index (BMI) nor VFA was a predominant determinant of HOMA-IR and IMT. IMT in HD patients with high SFA/low BMI groups was significantly higher than in the low SFA/high BMI groups.

Conclusion. It appears that there is a close relationship between SFA and insulin resistance or atherosclerosis in HD patients. It was suggested that SFA plays important roles related to carbohydrate or lipid metabolism in HD patients.

Keywords: abdominal fat accumulation; atherosclerosis; haemodialysis; insulin resistance; intima–media thickness

Received for publication: 15. 7.08
Accepted in revised form: 23. 5.09


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