Metabolic Syndrome and the Risk for Chronic Kidney Disease among Nondiabetic Adults

TLDR

Metabolic syndrome is a known risk factor for diabetes and cardiovascular disease, yet its prospective association with chronic kidney disease had not been examined. In the ARIC study, 10,096 nondiabetic adults with normal baseline kidney function were followed for nine years, with metabolic syndrome defined by NCEP guidelines and incident CKD defined as eGFR < 60 mL/min/1.73 m² at year 9 among those with baseline eGFR ≥ 60. During nine years, 7 % developed CKD, and those with metabolic syndrome had a 43 % higher odds of CKD (OR 1.43, 95 % CI 1.18–1.73), with a dose–response across trait number and an adjusted OR of 1.24 after accounting for diabetes and hypertension, confirming an independent association.

Abstract

The metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease; however, no prospective studies have examined the metabolic syndrome as a risk factor for chronic kidney disease (CKD). A total of 10,096 nondiabetic participants who were in the Atherosclerosis Risk in Communities study and had normal baseline kidney function composed the study cohort. The metabolic syndrome was defined according to recent guidelines from the National Cholesterol Education Program. Incident CKD was defined as an estimated GFR (eGFR) <60 ml/min per 1.73 m2 at study year 9 among those with an eGFR > or =60 ml/min per 1.73 m2 at baseline. After 9 yr of follow-up, 691 (7%) participants developed CKD. The multivariable adjusted odds ratio (OR) of developing CKD in participants with the metabolic syndrome was 1.43 (95% confidence interval [CI], 1.18 to 1.73). Compared with participants with no traits of the metabolic syndrome, those with one, two, three, four, or five traits of the metabolic syndrome had OR of CKD of 1.13 (95% CI, 0.89 to 1.45), 1.53 (95% CI, 1.18 to 1.98), 1.75 (95% CI, 1.32 to 2.33), 1.84 (95% CI, 1.27 to 2.67), and 2.45 (95% CI, 1.32 to 4.54), respectively. After adjusting for the subsequent development of diabetes and hypertension during the 9 yr of follow-up, the OR of incident CKD among participants with the metabolic syndrome was 1.24 (95% CI, 1.01 to 1.51). The metabolic syndrome is independently associated with an increased risk for incident CKD in nondiabetic adults.