Original articleObesity markers associated to albuminuria in a primary care center in Lima, PerúMarcadores de obesidad asociados a albuminuria en un centro de atención primaria de Lima, Perú☆
Introduction
Albuminuria is defined by the National Kidney Foundation in the Kidney Disease Outcomes Quality Initiative as urine albumin >30 mg/24 h,1 and is an indicator of vascular permeability secondary to an intraglomerular hemodynamic anomaly.2, 3 Different studies have found the presence of albuminuria in the general population to be a predictor of cardiovascular diseases and of chronic kidney disease.4, 5, 6, 7
The main risk factors for the appearance and development of albuminuria are arterial hypertension (AHT), type 2 diabetes mellitus (T2DM) and obesity.4, 5, 8 However, the physiopathology of albuminuria varies among different disease conditions. In this regard, albuminuria in AHT is essentially related to endothelial dysfunction, while in T2DM it is related to damage to the glomerular filtration membrane, intraglomerular hypertension and hyperfiltration that leads to diabetic neuropathy.9, 10
Obesity is usually evaluated by means of different markers such as the body mass index (BMI), the waist-to-height ratio (WHtR) and abdominal circumference (AC). In obese individuals, albuminuria can appear as a consequence of structural alterations to the glomerular filtration barrier secondary to hyperfiltration.9, 11 Such potential damage underscores the need for screening initiatives and early interventions in order to avoid albuminuria and thus prevent cardiovascular diseases or the progression of chronic kidney disease in obese patients.
Although the association between obesity and albuminuria has been studied in European, North American and Asian populations with their particular anthropometric characteristics,12, 13, 14 few studies have evaluated and compared the usefulness of obesity markers as risk measures of albuminuria in Latin American populations. It is therefore difficult to establish precise recommendations for these populations regarding obesity control with a view to reducing the risk of albuminuria.
The present study was thus carried out to evaluate the association between three obesity markers (BMI, AC and WHtR) and albuminuria in adults seen in a primary care center specializing in chronic diseases in Lima (Peru).
Section snippets
Study design
A secondary analysis was made of the case histories database of the Diabetes and Hypertension Center (Centro de Diabetes e Hipertensión [CEDHI]) of the national Public Health system (Seguro Social [EsSalud]) in Lima (Peru). This center receives patients ≥18 years of age referred from the primary care centers belonging to the Rebagliati – EsSalud healthcare network for annual control.
Population and sample
We analyzed all the case histories of the patients attending the CEDHI between 1 January and 31 August 2011,
Descriptive analysis
We evaluated a total of 1476 case histories of patients who attended the CEDHI between January and August 2011. A total of 228 patients were excluded due to a lack of albuminuria results; a further 33 patients were excluded due to the presence of urinary infection as evidenced from the case history or urine sediment findings; and one pregnant patient was also excluded. This left a total of 1214 patients who met the eligibility criteria and who were included in the analysis.
The mean patient age
Discussion
In our study population AC and the WHtR were seen to be associated with albuminuria, though the BMI was not. In both genders, the AUC values corresponding to the BMI, AC and the WHtR were found to be similar. The optimum cut-off point (i.e., that affording the best sensitivity/specificity balance) for the BMI and AC in women was found to be greater than the conventional cut-off point, while in males the optimum cut-off point was lower than the conventional cut-off point. However, in the case of
Conflicts of interest
The authors state that they have no conflicts of interest.
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Please cite this article as: Quintanilla AE, Taype-Rondan Á, Lazo-Porras M, Herrera-Añazco P. Marcadores de obesidad asociados a albuminuria en un centro de atención primaria de Lima, Perú. Endocrinol Diabetes Nutr. 2017;64:295–302.