1. Mrs. Watcharasa Pitug ID. 567110011-2 The Association between Waist Circumference and Renal Insufficiency among Hypertensive Patients 15/10/58 1

2. Contents Background/Rationale Objective Methods Results Discussion &Conclusions 15/10/58 2

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) 15/10/58 3

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 15/10/58 4

5. Modification of Diet in Renal Disease (MDRD) in Thailand In 2007 : Chronic Renal Insufficiency patients 13.2% in state 3 and 0.61% in state 4 (Thawee Siriwong, 2007) In 2008 : Chronic Renal Insufficiency patients in Thailand 17.5% ( สมาคม โรคไตแห่ง ประเทศไทย, 2008) 15/10/58 5

6. Clinical complications of renal failure Parathyroid gland disturbances –renal bone disease Active vitamin D deficiency Atherosclerosis and arteriosclerosis Polyneuropathy No diuresis –overhydration..and many others Malnutrition/wasting Immunodeficiency Myocardial fibrosis and cardiomyopathy Loss of erythropoietin – anaemia 15/10/58 6

7. Gab of knowledge 15/10/58 7 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 waist circumference influences Renal insufficiency independently 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. Fabiana et al.,2008

8. Methods Analytic study was conducted all information were collected from medical records of all patients diagnosed with Hypertension during 2012. The type of hypertension complications was based on Renal insufficiency was the main outcome of this study. 15/10/58 8 Objective To investigate the association between waist circumference and Renal insufficiency among hypertensive patients

9. 15/10/58 9 The inclusion flow chart Sampling frame DM, HT & DMHT N=61,706 Sample only HT patients (n=32,768) Study participants (n= 9,481 ) Exclude DM & DMHT (n=28,938) Exclude if not estimate waist circumference (n=23,287) Methods

10. Modification of Diet in Renal Disease (MDRD) in Thailand 15/10/58 10 Methods Go AS et., 2004

11. 15/10/58 11 Methods Variables and measurements

12. 15/10/58 12 variablesOutcome measurements Co-variated Cholesterol(mg/dl)0= Chol =170 Triglyceride(mg/dl)0=TG =150 HDL(mg/dl)0= HDL male >=40; HDL female >=50 1= HDL male <40; HDL female <50 LDL(mg/dl)0= LDL =100 Hemoglobin (g/dl) normal (male HGB ≥14; female HGB≥12) low (male HGB <14; female HGB<12) Hematocrit normal (male HCT ≥42; female HCT≥37) low (male HCT <42; female HCT<37) Variables and measurements Methods

13. 15/10/58 13 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). Statistic Analysis Methods

14. 15/10/58 14 Results Basic characteristic of the individual included in the study

15. 15/10/58 15 Results Basic characteristic of the individual included in the study

16. 15/10/58 16 Results Basic characteristic of the individual included in the study

17. 15/10/58 17 Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor

18. 15/10/58 18 Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor

19. 15/10/58 19 Odds ratios (ORs) of having Renal Insufficiency and their 95% confidence intervals for each factor adjusted for all other factors presented in the table using logistic regression (n=13151)

20. 15/10/58 20 Odds ratios (ORs) of having Renal Insufficiency and their 95% confidence intervals for each factor adjusted for all other factors presented in the table using logistic regression (n=13151)

21. 15/10/58 21 Forest plot was compare for each factors affecting chronic renal insufficiency, presented as odds ratio adjusted for waist circumference, age, gender, BMI, smoking, triglyceride, and Hemoglobin, using multiple logistic regression

22. Discussion & Conclusions 15/10/58 22 1 1 2 2

23. 15/10/58 23 Discussion & Conclusions

24. 15/10/58 24 Discussion & Conclusions

25. 15/10/58 25 Discussion & Conclusions In summary, in agreement with the findings in the general population, the present study shows that WC is not associated with Chronic Renal Insufficiency in individuals. In previous study, associations found between WC and some CVD risk factors were similar to those observed for visceral fat, suggesting that WC is a simple and economic tool to be used more often in epidemiological research also involving patients with CKD. Prospective studies are necessary to evaluate the reproducibility of WC and the ability of this method to predict outcomes in patients with CKD.

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