Metabolic syndrome increases risk for CKD
MedWire News: Elderly men and women with the metabolic syndrome are at increased risk for having or developing chronic kidney disease (CKD), show results of a study conducted in Taiwan.
High insulin resistance is also associated with an increased risk for prevalent, but not incident, CKD and with a rapid decline in renal function, report researchers in the Journal of Clinical Endocrinology and Metabolism.
Chung-Jen Yen and colleagues from the National Taiwan University Hospital in Taipei conducted a prospective cohort study among 1456 Asian men and women, aged 65 years and older, to investigate the effect of the metabolic syndrome and insulin resistance on the development of CKD.
At baseline, 38.7% of participants had the metabolic syndrome and 24.4% had prevalent CKD.
The researchers report that the prevalence of CKD significantly and positively correlated with the number of metabolic syndrome components present. Participants with three, four, or five components were 2.68, 2.36, and 4.12 times more likely to have CKD, respectively, than those with none.
People who met the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome were 1.78 times more likely to have CKD than those who did not, after adjustment for potential confounders.
Furthermore, in multivariate analysis, the individual metabolic syndrome components of high blood pressure (odds ratio [OR]=2.04), low high-density lipoprotein (HDL) cholesterol level (OR=1.58), high triglyceride level (OR=1.70), and high fasting plasma glucose level (OR=1.46) were all significantly associated with an increased likelihood for having CKD at baseline.
During the mean 3.2-year follow-up period, there were 67 (7.3%) cases of incident CKD, defined as new onset of proteinuria and an estimated glomerular filtration rate less than 60 mL/min per 1.73 m2.
People with the metabolic syndrome at baseline had a significant 1.93-fold increased risk for developing CKD than those without it, after adjustment for confounding factors. Among the individual components of the metabolic syndrome, increased fasting glucose level showed the strongest effect on incident CKD (hazard ratio [HR]=2.24). A strong association with incident CKD was also observed for increased triglyceride level (HR=1.95).
When the researchers looked at insulin resistance in a subset of 652 nondiabetic participants, they found that each unit increase in the homeostasis model assessment of insulin resistance (HOMA-IR) was associated with a 31% increased risk for prevalent CKD and a 27% increased risk for proteinuria.
Insulin resistance was not, however, associated with incident CKD, the researchers note. They say that this finding is "intriguing" and may indicate that other factors such as diabetes, high blood pressure, urinary tract obstruction, and/or infection may be necessary to lead the development of new CKD.
They conclude: "Further studies are needed to assess the impact of treating metabolic syndrome and insulin resistance on renal outcomes in elderly."
By Laura Cowen