비만과 만성 신장 질환 = Obesity and Chronic Kidney Disease

국문 초록 (Abstract)

만성 신장 질환은 심혈관계 질환과 연관된 사망률을 높이는 질환으로 비만인구의 증가와 함께 그 유병률이 전세계적으로 증가하고 있다. 단면 연구와 코호트 연구에서 체질량지수의 증가는 만성 신장 질환의 발생 위험을 유의하게 증가시켰고 신기능의 악화를 유발함을 보여 주었다. 비만은 과도한 지방조직에 의한 신장의 압박, 교감신경계 및 레닌-안지오텐신 시스템의 활성화, 인슐린 저항성, 염증성 사이토카인 (interleukin-6, tumor necrosis factor–α)의 증가 등 다양한 기전으로 신장의 구조적 변화 및 기능의 감소를 유발한다. 또한 지방세포에서 분비되는 렙틴, 아디포넥틴과 같은 아디포카인이 만성 신장 질환에서 현저히 증가되어 있고 이들에 의한 인슐린 신호 전달, 내피세포 기능 이상, 염증성 사이토카인의 증가 등을 통하여 심혈관계 합병증 및 조기 사망들에 기여한다. 투석을 받는 말기 신부전환자에서의 체질량지수가 높은 환자의 생존률이 더 좋은 상반된 결과를 보이는데 이는 동반된 만성 질환, 염증, 인슐린 저항성과 혈관 손상 등 다양한 원인으로 설명이 되겠지만 좀 더 규명이 필요하다. 비만은 교정가능한 위험요인으로서 만성 신장 질환의 발생과 진행뿐만 아니라 만성 신장 질환의 다른 주요 원인인 심혈관계 위험인자들과도 밀접한 연관성을 가지므로 이에 대한 적극적인 관리가 필요하다.

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