1. Mrs. Watcharasa Pitug ID. 567110011-2
The Association between Waist-to-Hight ratio, waist circumference,and Body Mass Index as Risk Factors for Chronic Renal Insufficiency among Type 2 Diabetes and Hypertension patients
Mrs. Watcharasa Pitug ID
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2. Contents Background/Rationale Objective Methods Results
Discussion &Conclusions
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3. Background/Rationale
Chronic kidney disease (CKD) has become a global public health problem and is a common condition in the United States
(Alejandro et al.,2009 ; Essam et al.,2008 ; Adam et al., 2007)
In 2004, there were approximately 472,000 patients with treated ESRD (Alejandro et al.,2009 )
By 2030, expected to increase to more than 2 million. The estimated prevalence of earlier CKD stages (stages 1 through 4) in US adults was 24 to 28 million based on the 2000
(Adam et al., 2007)
in Thailand : Chronic Renal Insufficiency patients 13.2% in state 3 and 0.61% in state 4 (Thawee Siriwong, 2007) and up to 13.5 in 2008
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4. Chronic kidney disease: classification and clinical consequences
Relative risk of death in relation to kidney function
(N=1,120,295 pts)
CKD -KDOQI classification
Go AS et., 2004
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5. Clinical complications of renal failure
Loss of erythropoietin –anaemia
Parathyroid gland disturbances –renal bone disease
Myocardial fibrosis and cardiomyopathy
Active vitamin D
deficiency
Immunodeficiency
Atherosclerosis
and
arteriosclerosis
Malnutrition/wasting
..and many others
Polyneuropathy
No diuresis –overhydration
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6. Gab of knowledge Fabiana et al.,2008
The relationship of obesity to Renal insufficiency is somewhat controversial. While it is established that obesity increases the risk of hypertension, diabetes and dyslipidemia
it is not clear if excess WHtR, WC, and BMI influences Renal insufficiency
Correlation between waist circumference and (A) visceral and (B) subcutaneous fat areas assessed by using computed tomography in 75 men (open circle; dotted lines) and 47 women (filled triangle; solid lines) with prevalent chronic kidney disease.
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Fabiana et al.,2008

7. Objective
To investigate the association between WHtR, WC, and BMI and Renal insufficiency among DM and HT patients
Methods
Analytic study was conducted all information were collected from medical records of all patients diagnosed with Hypertension during The type of DM HT and DM with HT complications was based on Renal insufficiency was the main outcome of this study.
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8. The inclusion flow chart for study participants
Methods
The inclusion flow chart for study participants
3,373,089 patients who visiting Hospitals in care
174,578 patients were randomized
112,976 were excluded
Year 2010,2011;
No data.
61,602 patients were DM,HT and
DM with HT in year 2012
Study participants
(n=61,602)
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9. Modification of Diet in Renal Disease (MDRD) in Thailand
Methods
Modification of Diet in Renal Disease (MDRD) in Thailand
Go AS et., 2004
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10. Statistic Analysis Methods
Demographic characteristics were described using frequency and percentage for categorical data such as gender, age group,WC group, BMI group, Cigarette smoking use, fasting plasma glucose group, total cholesterol group, triglyceride group, HDL cholesterol group, LDL cholesterol group, hemoglobin group and hematocrit group.
Using mean, standard deviation, median, minimum, and maximum to described continuous data such as age, BMI, fasting plasma glucose level, total cholesterol level, triglyceride level, HDL cholesterol level, LDL cholesterol level, hemoglobin level and hematocrit level.
To investigate factors that associated with chronic renal insufficiency, adjusted odds ratios (ORs) and their 95% confidence intervals (95%CIs) were estimated using multiple logistic regression.
All test statistics were p-value of less than 0.05 was considered statistical significant.
All analyses were performed by using STATA version 12.0 (AtataCorp, College Station, TX).
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11. Basic characteristic of the individual included in the study
Results
Basic characteristic of the individual included in the study
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12. Basic characteristic of the individual included in the study
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13. Basic characteristic of the individual included in the study
Other basic characteristic presented in table 2
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14. Factors associated with CRI
Univariate Analysis
Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor
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15. Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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16. Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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17. Multivariate Analysis
BMI for adjustment other factors
Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor
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18. Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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19. Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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20. Fig. 2 Forest plot of adjusted odds ratio for compare having BMI for each factor
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21. WC for adjustment other factors
Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor
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22. Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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23. Fig. 3 Forest plot of adjusted odds ratio for compare having WC for each factor
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24. Waist-to-hight for adjustment other factors
Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor
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25. Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor (cont.)
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26. Fig. 4 Forest plot of adjusted odds ratio for compare having WHtR for each factor
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27. Discussion
BMI
BMI is a less specific measure less able to differentiate between visceral and subcutaneous fat, as well as between central and peripheral fat
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Essam et al., 2008

28. Waist circumference Computed tomography
Discussion
Waist circumference
Computed tomography
Waist circumference, provides information about body shape and fat distribution
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29. Waist-to-Hight
Critically, excess visceral and peripheral fat, more so than subcutaneous fat, is associated with CVD and CVD risk factors.
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Fox et al., 2007

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31. Conclusions
In summary, in agreement with the findings in the general population, the present study shows that WHtR,WC,and BMI was associated with Chronic Renal Insufficiency.
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32. Thanks for your attention
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