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Does Metabolic Syndrome and Its Components Have Prognostic Significance for Renal and Cardiovascular Outcomes in IgA
Balázs Sági1,2, Tibor Vas1, Botond Csiky1,2
1Medical School, Clinical Center, 2nd Department of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 7624 Pécs, Hungary.
Insights
Metabolic syndrome significantly increases cardiovascular and renal events in IgA nephropathy (IgAN) patients. Managing metabolic risk factors is crucial for improving prognosis in chronic kidney disease (CKD).
Area of Science:
- Nephrology
- Cardiology
- Metabolic Diseases
Background:
- IgA nephropathy (IgAN) patients face higher cardiovascular (CV) mortality and morbidity than the general population.
- Metabolic syndrome (MetS) and its risk factors are independent predictors of CV disease and kidney disease progression.
- Understanding metabolic characteristics' impact on prognosis in IgAN patients with chronic kidney disease (CKD) is vital.
Purpose of the Study:
- To investigate the relationship between metabolic characteristics and prognosis in a homogeneous population of IgA nephropathy (IgAN) patients.
- To assess the impact of metabolic syndrome (MetS) on cardiovascular (CV) and renal outcomes in IgAN patients.
Main Methods:
- A cohort of 145 IgA nephropathy (IgAN) patients (CKD stages 1-4) was monitored for a median of 190 months.
- Composite endpoints included all-cause mortality, cardiovascular events (stroke, myocardial infarction, revascularization), and renal events (end-stage renal disease, renal replacement therapy).
- Patients were categorized into groups with and without metabolic syndrome (MetS) for comparative analysis.
Main Results:
- Patients with MetS experienced significantly more primary composite endpoint events (CV and renal) compared to those without MetS (p < 0.001).
- MetS was associated with a statistically significant increase in both renal (p = 0.001) and CV (p = 0.029) endpoints when analyzed separately.
- Cox regression identified dyslipidemia, eGFR, hemoglobin, urine albuminuria, and diabetes mellitus as independent predictors of survival. Increased MetS components correlated with higher primary endpoint rates (p = 0.012).
Conclusions:
- Metabolic profile significantly influences prognosis for both renal and cardiovascular endpoints in IgA nephropathy (IgAN) patients.
- Body Mass Index (BMI), hyperuricemia, hypertension, and diabetes are identified as key predictive factors for IgAN prognosis.
- Early identification and management of metabolic risk factors are essential for improving outcomes in IgAN patients with chronic kidney disease (CKD).
Background:
Patients with IgA nephropathy (IgAN), a chronic kidney disease (CKD), are significantly more likely to have cardiovascular (CV) mortality and morbidity than the general population. The occurrence of metabolic syndrome (MetS) and metabolic risk factors are independent risk factors for CV disease and renal progression. The purpose of this study was to determine how metabolic characteristics in a homogeneous population of CKD patients relate to prognosis.
Methods:
A total of 145 patients with CKD stages 1-4 diagnosed with IgA nephropathy (92 men and 53 women, aged 54.7 ± 13 years) were examined and monitored for a median of 190 months. All-cause mortality and any CV event, such as stroke, myocardial infarction, revascularization (CV), end-stage renal disease, and renal replacement therapy (renal), have been included in the composite endpoints (CV and renal).
Results:
Patients with MetS had significantly more primary endpoint events (23/65 patients vs. 15/60 patients, p < 0.001) compared to the non-MetS group. The MetS group had a statistically significant increase in both primary renal and CV endpoints (18/65 vs. 10/60, p = 0.001), and in CV endpoint events (7/65 vs. 6/60, p = 0.029) among the secondary endpoints (CV and renal separately). Based on Cox regression analysis, the main endpoint independent predictors of survival were dyslipidemia, eGFR, hemoglobin, urine albuminuria, and diabetes mellitus. Independent predictors of secondary renal endpoints were dyslipidemia, hemoglobin, urine albumin, and eGFR. Predictors of secondary cardiovascular endpoints were gender, BMI, and diabetes. When Kaplan-Meier curves were analyzed at the combined endpoints (CV and renal) or each endpoint independently, significant differences were seen between MetS and non-MetS. With more MetS components, the primary endpoint rate increased significantly (MetS comp. 0 vs. MetS comp. 2+, primary endpoints, p = 0.012).
Conclusions:
Our results show that the metabolic profile has a prognostic role not only for renal endpoints but also for CV endpoints in IgAN. BMI, hyperuricemia, hypertension, and diabetes have a predictive value for the prognosis of IgA nephropathy.
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