Cardiovascular Disease Common in Obese Diabetics With End-Stage Renal Disease

People with obesity, diabetes, and end-stage renal disease have more comorbidities and are less likely to be on a renal transplant waiting list, despite being younger, according to research published in Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy. These patients may also benefit from targeted education about prevention and therapeutics.

Researchers conducted a retrospective, cross-sectional study of people with diabetes, obesity, and end-stage renal disease in order to describe comorbidity profiles among this patient population. Patient data were collected from the Renal Epidemiology and Information Network (REIN) registry from one region in France (Provence-Alpes-Côte d’Azur; PACA).

Two models were utilized for data analysis. First, participants were divided into 2 groups: obese-diabetic, including those who had obesity and diabetes, and nonobese-nondiabetic, obese only, and diabetic only, including participants with only obesity or diabetes, and those without either condition. The second model divided people with end-stage renal disease (ESRD) into 4 groups: obese-diabetic, nonobese-nondiabetic, obese only, and diabetic only.

The total cohort included 4491 people with end-stage renal disease (obese and diabetic n=623; obese only n=292; diabetes only n=1330; nonobese and nondiabetic n=2246). Patients in the obesity-diabetes group were primarily men (55.1%), and 36.1% were aged 75 years or older. Fewer patients in the obesity-diabetes group were on the renal transplant waiting list compared with patients in other groups (8.8% vs 14.6%), due to medical contraindications.

Investigators conducted a binary logistic regression analysis of comorbidities (and other medical and demographic variables) and found that only 4 of these comorbidities were significant: cardiovascular disease, coronary insufficiency, chronic obstructive pulmonary disease, and cancer (odds ratios [ORs], 1.38, 1.49, 1.75, and 0.68, respectively).

In a multivariate analysis, the researchers identified several other variables associated with the obesity-diabetes group on renal replacement therapy: younger age (OR, 0.46), in-center dialysis (OR, 1.29), and smoking status (OR, 0.51).

Results of a multinomial regression analysis demonstrated differing profiles between patients in the obese-diabetes group, the nonobese-nondiabetes group, and the diabetes only group. Patients in the nonobese-nondiabetes group were older (>75 years; OR, 2.40) and were less likely to be women (OR, 0.63).

These patients were more likely to be on the renal transplant waiting list and less likely to be receiving in-center dialysis (ORs, 2.33 and 0.69, respectively). This group also had fewer comorbidities, including chronic obstructive pulmonary disease (COPD), coronary insufficiency, and arteritis of the lower limb, although they were more likely to have cancer and be smokers (ORs, 1.78 and 2.36, respectively).

Patients in the diabetes-only group were also more likely to be older and to be on the renal transplant waiting list (ORs, 2.09 and 1.92, respectively), compared with the obesity-diabetes group. Additionally, fewer people in this group had COPD, despite this group having more smokers (ORs, 0.56 and 1.48, respectively).

Study limitations include a lack of generalizability outside of a single region in France.

“The novelty of our study is of great importance, as we believe no such analysis has been carried out before,” the researchers wrote. “Another study on the same topic from a registry of a different region will certainly help in understanding regional similarities, differences, and the number of associated comorbidities in these patients.”

“Comorbidity profiles revealed that cardiovascular comorbidities, including coronary insufficiency along with COPD, were significantly associated with [people with obesity, diabetes, and end-stage renal disease,” the researchers concluded. “We suggest regular health education and awareness training by healthcare professionals to minimize the risk of comorbidities in these patients.”

Reference

Kakar A, Mouelhi Y, Loundou A, Crémades A, Gentile S. Comorbidity profiles among obese-diabetic end-stage renal disease patients: data from REIN registry of PACA region of France. Diabetes Metab Syndr Obes. 2021;14:617-625.