The Relationship Between Common Etiology Of Regular Hemodialysis Patients And Overweight

Background and purpose:The incidence and prevalence of End Stage Renal Disease(ESRD) are rising worldwide,with ESRD caused by diabetes and hypertension increasing most notablely.ESRD has become a great social and economic burden.If a risk factor for ESRD can be found and effectively treated,it will be of great importance.It is the fact that the prevalence of ESRD has risen in the past 20-30 years in tandem with an increased prevalence of obesity.And as obesity is closely associated with the two most important causes of ESRD,namely diabetes and hypertension,it seems likely that obesity may greatly increase the risk of ESRD.In this study we investigated the relationship between Body Mass Index(BMI) and the common causes of the regular hemodialysis patients,to confirm that obesity may be a risk for ESRD.For further verification,we detected 24-hour urinary albumin and the expression of fibronection (FN) mRNA in the renal cortex of obese rat,to support that obesity alone can induce renal injury.Methods:1. Subjects were selected from the regular hemodialysis patients in our blood purification center during January 2006 to December 2006,in line with the standards as follows:(1)chronic renal failure patients who needed regular hemodialysis therapy;(2)age≥20 years old;(3)current weight is dry body weight;(4)clear consciousness;(5)patients with acute renal failure were excluded.We investigated age,sex,the causes of ESRD, BMI at age 20,the hightest lifetime BMI and BMI at the time of interview.2. 20 male Wistar rats are for experiment.After a week of feeding adaptation,10 rats are randomly selected (OB group),and given high-fat diet feeding.Another 10 rats (C group),are given basic diet feeding.3 months later,rats of OB group became obese.The day before rats were killed,detected body weight,blood glucose,24-hour urinary albumin by ELISA method.After rats were killed,checked the weight of right kidney and used RT-PCR to detect the expression of FN mRNA in the renal cortex.Results: 1. 92 subjects conforming to the standard were selected.The common causes of ESRD are chronic glomerulonephritis(37cases,40.2%),diabetic nephropathy(15cases,16.3%),hypertensive nephropathy(12cases,13%),in turn.In diabetic nephropathy and hypertensive nephropathy group,the percentage of patients over 60 years old was significantly higher than that in chronic glomerulonephritis group (p<0.01).During all the period,the percentage of patients with overweight and obesity(BMI≥24) in diabetic nephropathy and hypertensive nephropathy group was significantly higher than that in chronic glomerulonephritis group (p<0.05).2. Compared with the C group,OB rats had significantly increased weight (p<0.01) and 24-hour urinary albumin (p<0.01).There was no significant difference in blood glucose and right kidney weight between the two group.The result of RT-PCR showed that compared with the C group,the OB group had a significantly increased expression of FN mRNA in renal cortex(p<0.01).Conclusion:1. Diabetes and hypertension,closely associated with obesity,have become the most two important causes of ESRD.Obesity is a risk for ESRD.2. Obesity alone can induce renal injury.