Metabolic Syndrome, ESRD, and Death in CKD

Abstract

SummaryBackground and objectives Previous studies reported an association between metabolic syndrome , incident CKD, and proteinuria. This study examined the associations between metabolic syndrome and its components with ESRD and death among those patients with stages 3 and 4 CKD (estimated GFR=15-59 ml/min per 1.73 m 2 ).Design, setting, participants, & measurements Patients with stages 3 and 4 CKD (n=25,868) who had data relating to metabolic syndrome and were followed in our health care system were identified using an electronic medical record-based registry. Cox proportional hazards models and competing risk analyses were used to study the associations between metabolic syndrome, its components (elevated BP, low HDL cholesterol, elevated serum triglycerides, impaired glucose metabolism, and obesity), and all-cause mortality and ESRD while adjusting for demographics, comorbid conditions, use of relevant medications, and renal function.Results Sixty percent of the study population (n=15,605) had metabolic syndrome. In the multivariate-adjusted analysis, presence of metabolic syndrome was associated with an increased risk for ESRD (hazard ratio=1.33, 95% confidence interval=1.08, 1.64) but not death (hazard ratio=1.04, 95% confidence interval=0.97, 1.12) during a mean follow-up of 2.3 years. Among the individual components of metabolic syndrome, impaired glucose metabolism, elevated triglycerides, and hypertension were associated with increased risk for ESRD, whereas low HDL cholesterol and impaired glucose metabolism were associated with higher risk of death.Conclusions Presence of metabolic syndrome is associated with ESRD but not death in patients with stages 3 and 4 CKD.Clin J Am Soc Nephrol 8: 945-952, 2013.

HDL Cholesterol Is Not Associated with Lower Mortality in Patients with Kidney Dysfunction

“…The fact that only Caucasian patients were included limits the generalization of the results to other races. Although a recent study found lower HDL-C levels to be associated with enhanced mortality during shortterm outcome in CKD patients with metabolic syndrome, 26 our data, rather, confirm recent experimental evidence revealing dysfunctional HDL in a variety of in vitro and in vivo assays under CKD conditions. 27 Nonetheless, additional interventional studies are necessary to definitely confirm a divergent effect of increasing HDL-C on cardiovascular mortality in participants with normal and reduced kidney function.…”

Prevalence and determinants of the metabolic syndrome among subjects with advanced nondiabetes-related chronic kidney disease in Gran Canaria, Spain

“…The metabolic syndrome was present in only 36.5% of the 1257 participants in the Third National Health and Nutrition Examination Survey (NHANES III) who had a creatinine clearance 545 mL/min, calculated using the Cockcroft-Gault formula. 15 Among studies on CKD cohorts, by analyzing data from an electronic medical record-based registry implemented in the Cleveland health care system, Navaneethan et al 16 found that the metabolic syndrome was present in 65.8% of 1815 subjects with Stage 4 CKD in whom data were available for its diagnosis. In another single center study from Taiwan, the prevalence of the syndrome was 69.4% in subjects with Stage 4 CKD and 53.3% in subjects with Stage 5 CKD.…”

“…20 Moreover, some investigations have observed that the presence of the metabolic syndrome accelerates the progression of renal function decline in patients with pre-existing renal disease. 16,17,25,26 On the other hand, it has been also be hypothesized that the metabolic syndrome could be the main cause of renal impairment in some patients with advanced stages of CKD. 27 Histological examination of kidneys from elective nephrectomy specimens has shown that patients with metabolic syndrome have greater tubular atrophy, interstitial fibrosis, and arterial sclerosis than matched controls.…”

Obesity/OSA/Metabolic Syndrome in Patients with CKD and Hypertension: The Missing Link?

“…In a large study [9], MetS was not linked with an increased risk of death in CKD stage 3-5 patients (individual components, such as low HDL cholesterol level and impaired glucose metabolism, were related with an increased risk for death, whereas obesity and HTN were related with a lower risk for death). No significant association between survival and BMI was shown in modification of diet in renal disease (MDRD) study [11].…”

“…In another recent study, Lee et al [8] found that the influence of MetS on CKD progression was major only in nondiabetic early stage (1-3) CKD subjects, and became nonsignificant in late-stage CKD and in diabetic (early or late) CKD patients. More recently, Navaethan et al found in a large and retrospective observational study including 25,868 patients with stage 3-4 CKD an independent association between MetS and ESRD [9]; the subgroup analysis showed that the association between MetS and ESRD was attenuated and no longer statistically significant with adjustment for proteinuria. In this context, in a recent editorial comment, Lea J. suggests that proteinuria could play a central role in the potential impact of MetS on CKD progression [9].…”