Metabolic Syndrome and Chronic Kidney Disease
Table 3 continued
Study
The Strong Heart Study45
Follow-up – Type of Study Patients and Ages
Prospective cohort study
Primary End-points
2,380 participants 45–74 years of age
Results – Conclusions
The association between METs Prevalence of CKD 7.8%; and CKD and incident cases of CKD developed
189 new cases/incidence
138/10,000 person years; CKD associated with METs, HR 1.3 (1.1, 1.6); METs associated with increased risk of developing CKD
AASK = African-American Study of Hypertension and Kidney disease; ACR = albumin creatinine ratio; ARIC = Atherosclerosis Risk in Communities study; CKD = chronic kidney disease; Creat = creatinine; ESRD = end-stage renal disease; GFR = glomerular filtration rate; HR = hazard ratio; IDF = International Diabetes Federation; MA = microalbuminuria; METs = metabolic syndrome; NCEP = National Cholesterol Educational Program; NHANES = National Health and Nutrition Examination Survey; NS = not significant; OR = odds ratio; RR = risk ratio.
CKD patients to be placed in the higher-risk group for subsequent cardiovascular events.30
Metabolic Syndrome as a Risk Factor for Chronic Kidney Disease
Metabolic syndrome has been linked with various atherosclerotic diseases and has been evaluated as a risk factor for the development of CKD in cross-sectional35–37
and longitudinal studies38–43 (see Table 3).
In a report from The National Health and Nutrition Examination Survey (NHANES) III, the metabolic syndrome in multivariate analysis significantly increased the risk of both CKD and microalbuminuria (adjusted odds ratio [OR] 2.6 and 1.9, respectively).35
In another
multivariate analysis, with a total of 6,980 participants 30–79 years of age, metabolic syndrome was a significant determinant of CKD. Comparisons among participants with and without each component of metabolic syndrome were made in both studies. It is noteworthy that there was a significant graded relationship between the number of components present and the corresponding prevalence of CKD.35,36 An important point in the study by Tanaka et al. was that metabolic syndrome was a significant determinant for younger participants <60 years of age, but not for older participants ≥60 years of age, and it was suggested that the metabolic syndrome was a significant determinant of CKD in men <60 years of age.36
The differential effect
of metabolic syndrome on CKD according to age and gender was also exemplified by the recent study by Yu at al. In this study, it was shown that there was a differential association between metabolic syndrome and CKD according to gender, age and menopausal status. These data support the notion that the metabolic syndrome is an independent determinant of CKD in younger men and post-menopausal women.44
In a representative sample of 15,160 Chinese adults 35–74 years of age, it was suggested that metabolic syndrome might be an important risk factor for CKD in Chinese adults. The multivariate-adjusted OR of the participants with CKD and elevated serum creatinine compared with those without metabolic syndrome were 1.64 and 1.36, respectively.37
The totality of the data from prospective studies supports the concept that metabolic syndrome is a risk factor for the development of CKD in participants with39 Japanese,40,41 (see Table 3).
Chinese39
or without diabetes,38,42 and Thai43
and in representative samples from the general population
Data from the Strong Heart Study were prospectively analysed. Metabolic syndrome was present in 896 (37.7%) and absent in 1,484 participants (62.3%) at baseline. The prevalence of CKD was 17.8%, with 388 new cases and an incidence of 342/10,000 person-years. The adjusted HR for CKD associated with metabolic syndrome was 1.3.
EUROPEAN NEPHROLOGY
The relationship between metabolic syndrome and kidney outcomes was stronger in those who developed diabetes during follow-up.45
It is
clear from the foregoing discussion that is important to bear in mind that the risk of metabolic syndrome for developing CKD is highly affected by the presence of diabetes and hypertension.42,45
Importantly, in a secondary analysis of the African-American Study of Hypertension and Kidney Disease (AASK) (a randomised controlled trial of blood pressure goal and agents in hypertensive African- Americans with CKD with primary outcomes of decrease in GFR of 50% or 25ml/minute/1.73m2, ESRD, death or a composite outcome of all three), metabolic syndrome was associated with proteinuria but was not independently associated with CKD progression.46
The research area was expanded and it was recently shown that metabolic syndrome was an independent risk factor for the development of CKD in Korean men without hypertension or diabetes, even with changes in status of metabolic syndrome over time.47
In a
study cohort composed of 10,685 healthy men without CKD, hypertension or diabetes who participated in a health check-up programme at a large work site, metabolic syndrome at baseline was associated with a significantly increased risk of CKD. Metabolic syndrome over time as a time-dependent variable also predicted the development of CKD. The relationship between metabolic syndrome and incident CKD remained significant, even after further adjustment for the homeostasis model assessment of insulin resistance, high- sensitivity C-reactive protein (CRP) level, current smoking, alcohol consumption or regular exercise. In addition, there were graded relationships between the number of metabolic syndrome traits, or quintile of homeostasis model assessment of insulin resistance over time as a time-dependent variable, and risk of CKD.47
Chronic Kidney Disease and
Components of the Metabolic Syndrome
Metabolic syndrome is a significant risk factor for the development of CKD; this finding is not surprising as all the components of the metabolic syndrome, this aggregation of risk factors, seem to be pathogenetic in CKD. The pathophysiological implications in such a multifactorial situation are probably too variable and not completely elucidated. In any case, it seems that the aforementioned graded relationship between the number of components present and the corresponding prevalence or increased risk of the development of CKD is well established.35,36,47
The greater the number of components
of metabolic syndrome present, the higher the incidence of CKD. An area of growing interest and focus has been the heightened recognition that every component of the metabolic syndrome individually or synergistically with others may be a risk factor for CKD development.
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