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Metabolic syndrome, ESRD, and death in CKD
Sankar D Navaneethan1, Jesse D Schold, John P Kirwan
1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. navanes@ccf.org
Insights
Metabolic syndrome increases end-stage renal disease (ESRD) risk in patients with chronic kidney disease (CKD) stages 3-4. However, it does not significantly impact mortality in this population.
Area of Science:
- Nephrology
- Metabolic Health
- Public Health
Background:
- Previous research linked metabolic syndrome to chronic kidney disease (CKD) and proteinuria.
- This study focuses on patients with established stages 3 and 4 CKD.
Purpose of the Study:
- To investigate the association between metabolic syndrome and its components with end-stage renal disease (ESRD) and mortality.
- To analyze these risks in a large cohort of patients with moderate to advanced CKD.
Main Methods:
- Utilized an electronic medical record registry to identify 25,868 patients with stages 3-4 CKD.
- Employed Cox proportional hazards models and competing risk analyses.
- Adjusted for demographics, comorbidities, medications, and renal function.
Main Results:
- Metabolic syndrome was present in 60% of the study population.
- Metabolic syndrome was associated with a 33% increased risk of ESRD (HR=1.33), but not all-cause mortality (HR=1.04).
- Impaired glucose metabolism, elevated triglycerides, and hypertension independently increased ESRD risk; low HDL cholesterol and impaired glucose metabolism increased mortality risk.
Conclusions:
- Metabolic syndrome is a significant risk factor for ESRD in patients with stages 3-4 CKD.
- Metabolic syndrome does not appear to increase the risk of all-cause mortality in this patient group.
Background 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.
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