Published in:
01-06-2009 | Guidelines
Chapter 8. CKD and lifestyle-related diseases
Published in: Clinical and Experimental Nephrology | Issue 3/2009
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An unhealthy lifestyle, such as obesity, insufficient exercise, alcohol, smoking, and other stresses, are assumed to be implicated in the development of CKD.
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Improvement in lifestyle has proven valuable in managing/treating CKD development and progression.
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Lifestyle-related diseases and metabolic syndrome have become popular subjects (Table 8-1). A lifestyle-related disease is defined as “a disorder whose development is greatly affected by individual lifestyle habits as well as genetic background”. Metabolic syndrome is a concept that excessive eating and lack of exercise causes fat accumulation in visceral organs, resulting in hypertension, diabetes, and dyslipidemia. Insulin resistance is considered to be an underlying causal factor in metabolic syndrome.Table 8-1Criteria of metabolic syndromeStorage of visceral fat (visceral adiopocytes)Waist circumferenceMen ≥ 85 cmWomen ≥ 90 cmArea of visceral fat: men/women ≥100 cm2Above and following factor of 2 and overHypertriglyceridemia and/or low high-density lipoprotein cholesterol≥50 mg/dL and/or <40 mg/dLSystolic blood pressure and/or diastolic blood pressure≥130 mmHg and/or ≥85 mmHgFasting blood glucose≥110 mg/dL
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Lifestyle-related disease and metabolic syndrome are closely related to the development of CKD. Obesity, particularly abdominal obesity that accumulates visceral fat, can easily cause proteinuria or reduced kidney function. An epidemiologic study conducted in Japan has reported that patients with metabolic syndrome had a higher cumulative incidence and relative risk of CKD (Fig. 8-1).Fig. 8-1Incidence (left panel) and relative risk (right panel) of developing chronic kidney disease (CKD) in the presence (+)/absence (−) of metabolic syndrome (MS). GFR Glomerular filtration rate, DM diabetes mellitus. The data are quoted, with modification, from Ninomiya T et al. (Am J Kidney Dis 2006;48:383–391)×
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The prevalence of metabolic syndrome is currently increasing among the Japanese general population. Kidney dysfunction due to obesity is implied by insulin resistance, the magnitude of which has a positive relationship with the degree of proteinuria. Insulin resistance increases with decreasing in kidney function, thus producing vicious cycle. A similar vicious cycle arises in CKD between risk factors, such as high blood pressure and dyslipidemia (Fig. 8-2). It has recently been acknowledged that high blood pressure or obesity without diabetes also causes kidney dysfunction.Fig. 8-2Lifestyle-related visceral obesity and its relationship with CKD and other associated medical conditions. ASO Atherosclerotic disease×