Effects of Metabolic Syndrome on Chronic Kidney Disease

In-Chang Cho; Young-Won Kim; Yunbyung Chae; Tong-Wook Kim; Seok Joong Yun; Sang-Cheol Lee; Wun-Jae Kim; Yong-June Kim

doi:10.4111/kju.2009.50.3.261

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Cho, Kim, Chae, Kim, Yun, Lee, Kim, and Kim: Effects of Metabolic Syndrome on Chronic Kidney Disease

Original Article

Korean J Urol 2009;50(3):261-266.

Published online: 19 March 2009

DOI: https://doi.org/10.4111/kju.2009.50.3.261

Effects of Metabolic Syndrome on Chronic Kidney Disease

In-Chang Cho, Young-Won Kim, Yunbyung Chae, Tong-Wook Kim¹, Seok Joong Yun, Sang-Cheol Lee, Wun-Jae Kim, Yong-June Kim

From the Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea

¹Konkuk University College of Medicine, Chungju, Korea

Correspondence to: Yong-June Kim Department of Urology, Chungbuk National University College of Medicine, 62, Gaesin-dong, Heungdeok-gu, Cheongju 361-711, Korea TEL: 043-269-6134 FAX: 043-269-6129 E-mail: urokyj@cbnu.ac.kr

Received 24 September 2008 Accepted 21 October 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Metabolic syndrome (MS) has been identified as a causal risk factor for cardiovascular disease, stroke, and cardiovascular mortality. Recent studies have suggested a possible relation between MS and renal function. The aim of this study was to evaluate the influence of MS on renal function.

Materials and Methods

We analyzed 12,348 healthy Koreans who underwent a general health checkup. MS was defined as 3 or more of the criteria according to the National Cholesterol Education Program Adult Treatment Panel guidelines III (NCEP ATP III). The glomerular filtration rate (GFR) was estimated by the redefined Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was categorized into 3 categories according to the Kidney Disease: Improving Global Outcomes guidelines; I: GFR≥90 ml/min, II: 60-89 ml/min, III: 30-59 ml/min.

Results

The overall proportion with MS was 19.3%. Compared with populations without MS, those with MS showed a significantly decreased GFR. The prevalence of CKD increased with the number of MS components, and it was prominent in the group of males over 40 years of age. In multivariate analyses using age, sex, and individual MS components, age (odds ratio [OR]=20.40; 95% CI: 10.81-38.49), sex (OR=1.98; 95% CI: 1.51-2.60), and obesity (OR=1.48; 95% CI: 1.13-1.93) were strongly associated with CKD.

Conclusions

This study showed that MS is a significant determinant of CKD. Handling of correctable factors such as obesity may be considered one of the preventive modalities against the development of CKD.

Keywords: Metabolic syndrome, Obesity, Chronic renal insufficiency

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Fig. 1.

The prevalence of metabolic syndrome by number of components.

Fig. 2.

The prevalence of individual metabolic components. TG: triglyceride, HDL: high-density lipoprotein.

Fig. 3.

The prevalence of chronic kidney disease (CKD). CKD was categorized according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. I: GFR≥90 ml/min, II: 60-89 ml/min, III: 30-59 ml/min.

Table 1.

Baseline characteristics of the study population (n=12,348) by presence of metabolic syndrome

Variables	Absent	Present	p-value
No. of patients (%)	9,953 (80.7)	2,395 (19.3)
Age (years)	45.5±10.0	50.1±10.8	＜0.001
Height (cm)	165.1±8.4	164.8±9.1	0.091
Weight (kg)	62.8±10.0	72.6±10.8	＜0.001
BMI (kg/m²)	22.9±2.7	26.6±2.6	＜0.001
Systolic BP (mmHg)	119.9±15.0	136.6±16.0	＜0.001
Diastolic BP (mmHg)	75.4±10.0	85.5±10.4	＜0.001
Triglycerides (mg/dl)	121.6±73.6	244.1±131.	3 ＜0.001
HDL-c (mg/dl)	55.0±12.7	43.7±9.7	＜0.001
Fasting glucose (mg/dl)	90.2±14.7	105.1±30.8	＜0.001
GFR (ml/min per 1.73 m	m²) 84.3±16.7	81.6±18.4	＜0.001

BMI: body mass index, BP: blood pressure, HDL-c: high density lipoprotein cholesterol, GFR: glomerular filtration rate

Table 2.

Glomerular filtration rate by number of metabolic syndrome components

No. of MS risk factor	I	II	III	p-value
0	1,103 (28.4)	2,744 (70.6)	41 (1.1)	＜0.001
1-2	1,600 (26.4)	4,342 (71.5)	130 (2.1)
3-5	514 (21.5)	1,788 (74.9)	86 (3.6)
Total	3,217 (26.1)	8,874 (71.9)	257 (2.1)

MS: metabolic syndrome, CKD: chronic kidney disease. Data is number (percentage). The CKD was categorized into the 3 categories (I: GFR≥90 ml/min, II: 60-89 ml/min, III: 30-59 ml/ min) according to the Kidney Disease: Improving Global Outcomes (KDIGO)

Table 3.

Prevalence of chronic kidney disease by age, sex, and metabolic syndrome

Sex	Age	MS	I	II	III	p-value
Male	20-30	Absent 5	568 (33.8)	1,109 (66.0)	3 (2.0)	0.495
(%)		Present 1	122 (36.4)	213 (63.6)	0 (0.0)
	40-50	Absent 6	670 (17.0)	3,220 (81.7)	52 (1.3)	0.026
		Present 1	156 (14.5)	898 (83.8)	23 (2.1)
	＞60	Absent 1	132 (22.5)	432 (73.6)	23 (3.9)	0.029
		Present	27 (13.7)	161 (81.7)	9 (4.6)
Female	20-30	Absent 5	538 (40.5)	784 (59.0)	7 (0.5)	0.146
(%)		Present	20 (29.9)	46 (68.7)	1 (1.5)
	40-50	Absent 7	700 (35.8)	1,216 (62.3)	37 (1.9)	0.067
		Present 1	145 (36.2)	241 (60.1)	15 (3.7)
	＞60	Absent	95 (20.3)	325 (69.3)	49 (10.4	4) 0.085
		Present	44 (14.1)	229 (73.6)	38 (12.2	2)

MS: metabolic syndrome, CKD: chronic kidney disease. The CKD was categorized into the 3 categories (I: GFR≥90 ml/min, II: 60-89 ml/min, III: 30-59 ml/ min) according to the Kidney Disease: Improving Global Outcomes (KDIGO)

Table 4.

Univariate and multivariate analyses for prediction of chronic kidney disease

Variables	Univariate			Multivariate
Variables	OR	95% CI	p-value	OR	95% CI	p-value
Age	25.46	13.68-47.35	＜0.001	20.40	10.81-38.49	0.004
Sex	2.35	1.83-3.02	＜0.001	1.98	1.51-2.60	＜0.001
Obesity^a	1.81	1.41-2.32	＜0.001	1.48	1.13-1.93	0.004
Hypertension^a	1.83	1.43-2.35	＜0.001	1.08	0.83-1.41	0.561
High TG^a	1.43	1.11-1.83	0.005	1.11	0.84-1.47	0.445
Low HDL^a	2.14	1.66-2.77	＜0.001	1.26	0.95-1.67	0.108
Impaired fasting glucose^a	1.67	1.14-2.43	＜0.001	1.00	0.67-1.48	0.999

OR: odd ratio, CI: confidence interval, TG: triglyceride, HDL: high density lipoprotein

^a : component is absent or present

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