Vol. 1 No. 1 (2025): January - March
1-8
2025-11-01
Open Access

Influence of environmental and metabolic factors on kidney function in people with metabolically healthy obesity in the Southern Aral Sea region: results of a clinical and functional study

orcidA.G. Gadaev
orcidDon Eliseo III Lucero-Prisno
orcidR.Q. Dadabaeva
orcidR.I. Turaqulov
orcidI.I. Islomov

Received: 2025-11-24 11:41:28

Published: 2025-11-01

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Abstract

Aim. The Southern Aral Sea region is one of the most ecologically vulnerable regions of Central Asia, characterized by a harsh continental climate, high levels of atmospheric pollution (PM2.5), water scarcity, and dietary patterns with excessive consumption of carbohydrates and flour products. Against this background, there is a significant prevalence of obesity, including the phenotype of metabolically healthy obesity (MHO)—a condition in which there are no signs of metabolic syndrome, but overweight remains. Despite the apparent ‘‘metabolic norm”, such patients are susceptible to latent renal dysfunction with prolonged exposure to environmental factors. The aim of the study was to conduct a comprehensive assessment of the impact of environmental (PM2.5, water salinity, soil salinity) and metabolic factors on kidney function in patients with MHO in the Southern Aral Sea region, using the estimated glomerular filtration rate (eGFR) and functional renal reserve (FRR) before and after a 6-month intervention.


Materials and methods. The study included 133 participants (25–50 years old), divided into three groups: 1st—grade I MHO (BMI 30–34.9 kg/m²), 2nd—grade II MHO (BMI 35–39.9 kg/m²), and a control group of clinically healthy individuals. The main group received azilsartan 10 mg/day and structured physical activity (walking ≥60 minutes a day, ≥5 times a week). Renal function was assessed using CKD-EPI 2021 and the FRR test (0.5% NaCl salt load, 0.5% of body weight). The follow-up lasted 6 months.


Results. In patients from the Southern Aral Sea region, eGFR and FRR values were significantly lower than in the control group (eGFR—126.1 ± 1.7 and 123.7 ± 2.0 ml/min/1.73 m² vs. 131.1 ± 2.2 ml/min/1.73 m²; FRR—28.3 ± 3.5% and 24.3 ± 3.6% vs. 34.1 ± 2.2%, p < 0.05). After the 6-month intervention, patients with grade I MHO showed a 12% increase in FRR (p < 0.01), while those with grade II MHO demonstrated less pronounced improvements.


Conclusion. Patients with MHO living under environmental stress are at risk of early subclinical renal dysfunction, even if the metabolic profile remains preserved. Assessment of functional renal reserve makes it possible to detect disorders at the preclinical stage and can serve as an effective tool for early screening of chronic kidney disease. The results confirm the feasibility of using azilsartan and structured physical activity as a nephroprotective strategy in MHO populations.

Keywords

List of references

  1. Feng S, Li M, Fei J, et al. Ten-year outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for multivessel or left main coronary artery disease: A systematic review and meta-analysis. J Cardiothorac Surg. 2023;18:54. https://doi.org/10.1186/s13019-023-02101-y.

  2. Raja SG, Ilsley C, De Robertis F, Lane R, et al. Mid-to-long term mortality following surgical versus percutaneous coronary revascularization stratified according to stent subtype: An analysis of 6,682 patients with multivessel disease. PLoS One. 2018;13(2):e0191554. https://doi.org/10.1371/journal.pone.019155 4.

  3. Bajraktari G, Bytyçi I, Henein MY, Alfonso F, Ahmed A, Jashari H, Bhatt DL. Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials. Int J Cardiol Heart Vasc. 2020;29:100549. https://doi.org/10.1016/j.ijcha.2020.100549.

  4. Bruno F, Marengo G, De Filippo O, Wanha W, Leonardi S, et al. Impact of complete revascularization on development of heart failure in patients with acute coronary syndrome and multivessel disease: A subanalysis of the CORALYS Registry. J Am Heart Assoc. 2023;12(15):e028475. https://doi.org/10.116 1/JAHA.122.028475.

  5. Carson P, Wertheimer J, Miller A, O’Connor CM, Pina IL, Selzman C, et al. The STICH trial (surgical treatment for ischemic heart failure): Mode-of-death results. JACC Heart Fail. 2013;1:400–407. https://doi.org/10.1016/j.jchf.2013.04.006.

  6. Holmes DR Jr, Davis KB, Mock MB, Fisher LD, Gersh BJ, Killip T 3rd, et al. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: A report from the Coronary Artery Surgery Study. Circulation. 1986;73:1254–1263. https://doi.org/10.1161/01.CIR.73.6.1254.

  7. Huang D, Huo Y, Zhang S, Huang C, Han Y. Prevention of sudden cardiac death after revascularization for coronary heart disease. Int J Heart Rhythm. 2018;3:1–15. https://doi.org/10.3760/cma.j.issn.2095-4 279.2018.01.001.

  8. Kurbanov RD, Mullabaeva GU, Irisov JB. The influence of myocardial revascularization on ventricular arrhythmia in patients with ischemic heart disease. Med Sci. 2017;21(1):103–106.

  9. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126. https://doi.org/10.1093/eurheartj/ehac262.

  10. Bhat A, Gan GC, Tan TC, Hsu C, Denniss AR. Myocardial viability: From proof of concept to clinical practice. Cardiol Res Pract. 2016;2016:1020818. https://doi.org/10.1155/2016/1020818.

  11. Cleland JG, Calvert M, Freemantle N, Arrow Y, Ball SG, Bonser RS, et al. The Heart Failure Revascularisation Trial (HEART). Eur J Heart Fail. 2011;13(2):227–233. https://doi.org/10.1093/eurjhf/ hfq230.

  12. Effect of PCI on health status in ischemic left ventricular dysfunction: Insights from REVIVED-BCIS2. JACC Heart Fail. 2024;12(4):345–354. https://doi.org/10.1016/j.jchf.2024.03.010.

  13. Ndrepepa G, Cassese S, Byrne RA, Bevapi B, et al. Left ventricular ejection fraction change following percutaneous coronary intervention: Correlates and association with prognosis. J Am Heart Assoc. 2024;13(21):e035791. https://doi.org/10.1161/JAHA.124.035791.

  14. Wollmuth J, Patel MP, Dahle T, Bharadwaj A, et al. RESTORE-EF Investigators. Ejection fraction improvement following contemporary high-risk percutaneous coronary intervention: RESTORE-EF study results. J Soc Cardiovasc Angiogr Interv. 2022;1(5):100350. https://doi.org/10.1016/j.jscai.2022.100350.

  15. Bista R, Zghouzi M, Jasti M, Lichaa H, Kerrigan J, et al. Outcomes of percutaneous revascularization in severe ischemic left ventricular dysfunction. Curr Cardiol Rep. 2024;26(5):435–442. https://doi.org/10.1 007/s11886-024-02045-2.

  16. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2019;40(2):87–165. https://doi.org/10.1093/eurheartj/ehy394.

  17. Mehta SR, Wood DA, Storey RF, Mehran R, Bainey KR, Nguyen H, et al. COMPLETE Trial Steering Committee and Investigators. Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med. 2019;381(15):1411–1421. https://doi.org/10.1056/NEJMoa1907775.

  18. Boeken U, Feindt P, Litmathe J, Gams E. Comparison of complete and incomplete revascularization in CABG patients with severely impaired left ventricular function. Z Kardiol. 2004;93(3):216–221. https://doi.org/10.1007/s00392-004-0043-y.

  19. Saraste A, Maaniitty T. Significance of myocardial flow reserve after revascularization. Eur Heart J Cardiovasc Imaging. 2023;24(11):1478–1479. https://doi.org/10.1093/ehjci/jead151.

  20. Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM. Medication adherence interventions improve heart failure mortality and readmission rates: Systematic review and meta-analysis of controlled trials. J Am Heart Assoc. 2016;5(6):e002606. https://doi.org/10.1161/JAHA.115.002606.

  21. Üveges Á, Jenei C, Kiss T, et al. Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis. Int J Cardiovasc Imaging. 2019;35(10):1755–1763. https://doi.org/10.1007/s10554-019-01628-3.

About the Authors

orcid
A.G. Gadaev
abgadaev@yahoo.com
Tashkent state medical university
orcid
Don Eliseo III Lucero-Prisno
don-eliseo.lucero-prisno@lshtm.ac.uk
London School of Hygiene and Tropical Medicine
orcid
R.Q. Dadabaeva
rdadabaeva@mail.ru
Tashkent State Medical University
orcid
R.I. Turaqulov
rustamturakulov571@gmail.com
Tashkent State Medical University
orcid
I.I. Islomov
md.inomjon.islomov@gmail.com
Urgench state medical institute

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How to Cite

Influence of environmental and metabolic factors on kidney function in people with metabolically healthy obesity in the Southern Aral Sea region: results of a clinical and functional study (A. Gadaev, D. E. III Lucero-Prisno, R. Dadabaeva, R. Turaqulov, & I. Islomov, Trans.). (2025). Uzbek Scientific Journal of Internal Diseases, 1(1), 1-8. https://uzsjid.uz/index.php/jour/article/view/12

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