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Türk Erişkinlerinde Hafif Böbrek Fonksiyon Bozukluğu: Yaygınlığı ve İnsülin Direnci ile Yakın İlişkisi

Mild Renal Dysfunction Among Turkish Adults: Prevalence and Its Association With Insulin Resistance

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2006

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objectives: To investigate the prevalence of mild renal dysfunction and its association with insulin resistance (IR), meta¬bolic syndrome (MS) or its components among Turkish adults. Methods: Serum creatinine concentrations were measured in 1048 male and female subjects. After excluding cases with diabetes mellitus, 933 participants of a representative cohort were studi¬ed cross-sectionally. Glomerular filtration rate (GFR) was estimated based on serum creatinine concentrations using the Modification of Diet in Renal Disease formula. GFR was divided into 3 categori¬es constituting chronic kidney disease stages 2 and >3. MS was identified by modified criteria of the Adult Treatment Panel-III. Results: MS existed in 38.7% of the cohort. Mild renal dysfunction (estimated GFR 60 to 89.9 mL/min/1.73 m2) existed in 50% of the study sample in both genders. Compared to the group with normal GFR, in category II, age-adjusted estimates of body mass index, homeostatic model assessment (HOMA) index, blood pres¬sures, total, HDL-, LDL-cholesterol and serum proteins were all sig¬nificantly elevated in both genders, as were apo B and log TSH in women alone. Stated variables were also significantly and inver¬sely correlated with GFR. Whereas MS was not significantly asso¬ciated with GFR categories, nor with reduced GFR when controlled for HOMA, HOMA -adjusted for MS as well as for sex, age and systolic BP- was significantly associated with likelihood for redu¬ced GFR.Conclusions: Mild impairment of kidney function is very com¬mon in nondiabetic middle-aged and elderly adults, is associated mainly with IR and related cardiovascular risk factors, in the absen¬ce of MS-related atherogenic dyslipidemia. IR is important even in mild reduction in GFR, an action independent of central obesity-re¬lated components of MS.
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Abstract (Original Language): 
Amaç: Halkımızda serum kreatininde hafif bozukluğun ve bunun yansıttığı böbrek fonksiyon bozukluğunun yaygınlığı ve bunun insülin direnci (IR), metabolik sendrom (MS) veya bileşenleri ile arasındaki ilişkinin araştırılması. Yöntem: Serum kreatinin konsantrasyonları 1048 erkek ve kadında ölçüldü. Diyabet hastaları dışlandıktan sonra geri kalan 933 kişide glomerüler filtrasyon hızı da (GFR) Renal Hastalıkta Diyet Modifikasyonu förmülü esas alınarak kreatinin değerlerine göre tahmin edildi. GFR değerlerine göre bireyler evre 2 ve evre >3 kro¬nik böbrek hastalığı olanları da içerecek şekilde üç kategoriye ayrıldı. MS tanımı modifiye Adult Treatment Panel-III (ATP-III) kriterlerine göre yapıldı. Bulgular: Kohortun %38.7'inde MS mevcuttu. Hafif renal fonksiyon bozukluğu (MRD) varlığı (tahmini GFR: 60-89.9 mL/dak/1.73 m2 olanlar) her iki cinsiyet için geçerli olmak üzere çalışma popülasyonu-nun %50'sinde saptandı. Normal GFR'li grupla karşılaştırıldığında grup II'de, yaşa göre ayarlanmış vücut kitle indeksi (VKİ), homeostatik model değerlendirme (HOMA) indeksi, kan basınçları, total, HDL-kolesterol, LDL-kolesterol ve serum proteinleri her iki cinsiyet için, apo B ve log TSH değerleri ise yalnız kadınlarda anlamlı olarak yüksekti. Üstelik belirtilen değişkenler ile GFR arasında anlamlı ve ters bir ilişki de mevcuttu. Çokdeğişkenli analizde MS varlığı ile ne GFR grupları arasında, ne de HOMA için kontrollü azalmış GFR olasılığı arasında anlamlı bir ilişki vardı. Oysa cinsiyet, yaş ve sistolik kan basıncı yanısıra MS için ayarlı HOMA değerleri ile azalmış GFR olasılığı arasında anlamlı bir ilişki bulundu. Sonuç: Diyabeti bulunmayan orta ve ileri yaştaki erişkinlerimizin yarısında böbrek fonksiyonlarında hafif bozukluk mevcut olup bu, MS ile ilişkili aterojen dislipidemi bulunmaksızın, esas itibariyle IR ile ilişkilidir. IR varlığı, MS'in santral obezite ile ilişkili öğelerinden bağımsız biçimde, GFR'deki hafif azalmada bile önemli rol oynar.
FULL TEXT (PDF): 
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  • 4
197-206
  • Turkish

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