High VFA tied to poor cardiovascular outcomes in haemodialysis

In patients on haemodialysis (HD), a higher visceral fat area (VFA) may help predict cardiovascular events (CVEs) and deaths (CVDs), as well as all-cause mortality, a recent study has found.

Researchers prospectively analysed 97 HD patients (median age 48 years, 61.9 percent men) whose baseline, clinical, and serum biochemical information were accessed through their electronic medical records. Bioelectrical impedance analysis was used to evaluate body composition; computed tomography and echocardiography were also performed at enrolment. The primary endpoints included CVDs, CVEs, and all-cause death.

Over a median follow-up period of 26.4 months, 21 episodes of CVEs occurred in 20 patients, with a rate of 21.6 percent. Eight patients (8.2 percent) died of cardiovascular causes, while an additional three mortalities were from other causes.

Receiver operating characteristic (ROC) curve analysis found that VFA was a good predictor of CVEs (area under the curve [AUC], 0.76; p<0.001), outperforming even coronary artery calcification (CAC; AUC, 0.69; p=0.011). The optimal VFA cutoff value was 71.3 cm², such that patients at or above the threshold saw a significantly higher CVE frequency.

Cox proportional hazards analysis also showed that VFA ≥71.3 cm² was significantly associated with CVEs (hazard ratio [HR], 9.21; p=0.017). VFA had a similar correlation with CVD (HR per 1-cm² increase, 1.11; p=0.035) and all-cause mortality (HR per 1-cm² increase, 1.08; p=0.011).

“Our prospective observational study showed that increased VFA was a robust predictor for the occurrence of CVEs, CVD, and all-cause death in patients on HD,” the researchers said. “The predictive ability of VFA might result from the adverse effect of VFA on cardiac structure.”