Cardiorenal Fat: A Cardiovascular Risk Factor With Implications in Chronic Kidney Disease

Abstract

There is a growing interest in the potential role of adipose tissues in cardiac and renal pathophysiology, and determining the mechanisms by which fat compartments around the heart and kidneys influence cardiovascular disease is of clinical importance in both general and high-risk populations. Epicardial fat and perirenal fat have been associated with adverse outcomes in chronic kidney disease (CKD) patients. Epicardial fat is a rich source of free fatty acids and is capable of secreting inflammatory and pro-atherogenic cytokines that promote atherosclerosis through a local paracrine effect. Recent evidence has demonstrated that perirenal fat has a closer correlation with kidney diseases than other visceral fat deposits in obesity or metabolic disturbances. Moreover, perirenal fat has been reported as an independent risk factor for CKD progression and even associated with cardiorenal dysfunction. Accordingly, these forms of organ-specific fat deposits may act as a connecter between vascular and cardiorenal disease. This review explores the possible links between epicardial and perirenal fat and its significant role as a modulator of cardiorenal dysfunction in CKD patients.

Keywords: adipose tissue; cardiorenal disease; cardiovascular disease; chronic kidney disease; renal failure.

Figure 1

Possible physiological and pathological mechanisms of epicardial and renal fat in vascular beds. Schematic diagram illustrating the anatomical location of epicardial and perirenal fat around the heart and kidneys, its various pathophysiological functions and proposed pathways of damage with adverse clinical consequences. eGFR, estimated glomerular filtration rate; LDL, low density lipoprotein.

Figure 2

Proposed factors that improve or worsen epicardial or perirenal fat tissue accumulation in patients with chronic kidney disease. Diagram showing adipose tissue around the heart and kidney. In a pathological environment, this adipose tissue becomes a cardiovascular risk factor in susceptible populations. Current evidence has been published regarding the effect of lifestyle changes and weight loss or exercise. Moreover, medical intervention has supported the use of hypoglycemic agents and other drugs to reduce adipose tissue accumulation and/or dysfunction. Although further evidence regarding perirenal fat intervention is warranted in future studies, controlling metabolic abnormalities such as hyperglycemia, dyslipidemia or hyperuricemia may improve clinical outcomes.