1. Mrs. Watcharasa Pitug ID. 567110011-2 The Association between Waist Circumference and Renal Insufficiency among Hypertensive Patients 20/10/58 1

2. Contents Background/Rationale Objective Methods Results Discussion &Conclusions 20/10/58 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) 20/10/58 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 20/10/58 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) 20/10/58 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 20/10/58 6

7. Gab of knowledge 20/10/58 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. 20/10/58 8 Objective To investigate the association between waist circumference and Renal insufficiency among hypertensive patients

9. 20/10/58 9 The inclusion flow chart Sampling frame DM, HT & DMHT N=61,706 Sample only HT patients (n=32,768) Study participants (n= 22,121 ) Exclude DM & DMHT (n=28,938) Exclude if not estimate waist circumference (n=10,647) Methods

10. Modification of Diet in Renal Disease (MDRD) in Thailand 20/10/58 10 Methods

11. 20/10/58 11 Methods Variables and measurements

12. 20/10/58 12 Methods Statistic Analysis Statistic analyses were performed using STATA software, version12 Multiple logistic regression was used for data analysis Using mean and standard deviation for descriptive continuous variable Using frequency and percentage for categorical variable 95% confidence (CI) were calculated for each of these items

13. Results 20/10/58 13 Basic characteristic of the individual included in the study n=22,167 N=32,768

14. 20/10/58 14 Table 2. Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor

15. 20/10/58 15 Table 2. Crude odds ratios of having Renal Insufficiency and their 95% confidence intervals for each factor

16. 20/10/58 16 Table. 3. 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)

17. 20/10/58 17 Table. 3. 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)

18. Discussion & Conclusions 20/10/58 18

19. 20/10/58 19 Discussion & Conclusions

20. 20/10/58 20 Discussion & Conclusions

21. 20/10/58 21 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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