Prevalencia de enfermedad renal inicial en población sana. Relación con el Síndrome metabólico, riesgo cardiovascular y el hígado graso no alcohólico

    Student thesis: Doctoral thesis


    Objectives: 1. Main objectives: 1.1. To analyze the relation between the initial renal disease and the non-alcoholic fatty liver disease (NAFLD). 1.2. To study the prevalence of initial renal disease and the factors associated to it. 1.3. To analyze the association between the initial renal disease and the metabolic syndrome (MS), and the different components which act as risk factors to renal disease. 2. Secondary objectives: 2.1. To estimate the risk of coronary disease in patients suffering from initial renal disease according to REGICOR. 2.2. To study the prevalence of hepatic disease in the general population by hepatic elastography and its predictive value for detection of hepatic fibrosis. Materials and methods: Design of the study: Cross-sectional, descriptive, multicenter, population study. Study population: Individuals between 18 and 75 years-old from 16 different medical centers selected randomly of SIAP database for the study “Early detection of hepatic disease in healthy population”. Exclusion criterion: Chronic liver disease, severe diseases at advanced stages, cognitive impairment, severe mental disease, institutionalized individuals, or people that refused to consent for the study. Variables: Sociodemographic data, anamnesis (pathological background, toxic habits), physical exploration, arterial pressure, basal blood analysis, albumin/creatinine ratio (ACR) in urine samples, hepatic elastography, diagnosis of MS, REGICOR, non-invasive serological markers (FLI, NFS, FIB-4). Results: Population analyzed of 3.014 individuals: 42.5% men and 56.6% women. Prevalence of initial renal disease 3.8%, MS 28.6%, and NAFLD 39.7%. The three conditions were more frequent in men and increased with age. The initial renal disease was observed in the 7.9% of subjects with MS and in the 7.4% of subjects with NAFLD. The 4.3% of the population presented the three conditions in a concomitant manner. The factors associated to initial renal disease were overweight in the 34.8%, obesity in the 56%, prediabetes in the 53.8%, diabetes in the 43.1% and hypertension in the 59.6%. In the multivariate model, MS, NAFLD, and the male gender behaved as risk factors of initial renal disease, with an OR of 3.1 (95%CI 2.1-4.6), 3.7 (95%CI 2.3-5.8), and 3.01 (95%CI 1.74-5.23) respectively, fitted by age and gender. The initial renal disease behaved as a risk factor to NAFLD with an OR of 3.2 (95%CI 1.6-6.6). All components of SM were associated with the initial renal disease, with the exception of low levels of HDL. The ACR value (mg/g) increased with the presence of MS components, and the highest value was obtained when MS criteria were met (β=0.58; 95%CI 0.47-0.68). The 18.8% of population with REGICOR≥10 presented initial renal disease versus a 6.1% with REGICOR<10. The 9% of the individuals presented an elastography of ≥6.8 kPa, the 6.8% of ≥7.6 kPa, and the 5.8% of ≥8 kPa, which in comparison to the performed biopsies (92), classified correctly to the 32%, 39%, and 45% of patients with fibrosis respectively. The value with greater predictive capacity was 9.2 kPa (AUC 0.87). The prevalence of initial renal disease in individuals with elastography ≥6.8 kPa was 11%, with a high NFS of 14.1%, and with an elevated FIB-4 of 20%. Conclusions: The initial renal disease, the MS, and the NAFLD, are common conditions in the general population. MS and their components, except for HDL, were associated with the initial renal disease. There is a significant relation between the initial renal disease and the NAFLD. The hepatic elastography, in combination with serological markers, would be a good method to diagnose NAFLD and hepatic fibrosis in the risk population. The presence of the initial renal disease was more frequent among individuals with high REGICOR.
    Date of Award14 Sept 2017
    Original languageSpanish
    Awarding Institution
    • Clinical Pharmacology Department
    Supervisor Llorenç Caballeria Rovira (Director) & Josep Bonet Sol (Director)

    Cite this