Metabolic syndrome in chronic kidney disease and renal transplant patients in North India.
ABSTRACT The cluster of biochemical and clinical abnormalities known as metabolic syndrome (MS) has become a public health problem even in developing countries. Previous studies have shown a graded relationship between MS components and worsening renal function in the general population. The prevalence of MS in non-dialysis-dependent CKD (NDD-CKD) and kidney transplant recipients in the North Indian population is unknown.
We studied all patients with stable CKD and with renal transplantation attending the nephrology clinic in a large centre in North India over an eight-week period. All transplant patients had stable graft function for 3 months prior to recruitment. MS was defined according to the International Diabetes Federation (IDF) 2007 guidelines. A total of 252 (155 NDD-CKD and 97 renal transplant recipients) patients were studied.
MS was present in 86 (34%) patients. The prevalence of MS was similar in NDD-CKD and transplant patients [60 (39%) vs. 26 (27%), P = 0.052]. Patients with MS were older than those wihout MS (48 ± 12 years-old vs. 40 ± 14 years-old, P < 0.001) and MS was more common in women than in men (59% vs. 26%, P < 0.001). Female gender was an independent risk factor for MS in this population [adjusted OR 5.25 (95% CI: 2.74-10.06)]. With advancing CKD, the prevalence of MS decreased in the NDD-CKD patients. Impaired glucose tolerance and hypertriglyceridemia were independent predictors of MS. Hypertension was not a predictor of MS in NDD-CKD. In transplant recipients, hypertriglyceridemia, hypertension and low HDL cholesterol predicted the risk for MS.
MS is common in CKD and renal transplant patients in North India. The risk of MS decreases with declining eGFR in CKD patients. Female gender and hypertriglyceridemia independently predict the risk of MS in both NDD-CKD and transplant recipients.
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ABSTRACT: The metabolic syndrome is a common risk factor for cardiovascular disease. To examine the association between the metabolic syndrome and risk for chronic kidney disease and microalbuminuria. Cross-sectional study. The Third National Health and Nutrition Examination Survey. Participants 20 years of age or older were studied in the chronic kidney disease (n = 6217) and microalbuminuria (n = 6125) analyses. The metabolic syndrome was defined as the presence of 3 or more of the following risk factors: elevated blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, elevated glucose level, and abdominal obesity. Chronic kidney disease was defined as a glomerular filtration rate less than 60 mL/min per 1.73 m2, and microalbuminuria was defined as a urinary albumin-creatinine ratio of 30 to 300 mg/g. The multivariate-adjusted odds ratios of chronic kidney disease and microalbuminuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome were 2.60 (95% CI, 1.68 to 4.03) and 1.89 (CI, 1.34 to 2.67), respectively. Compared with participants with 0 or 1 component of the metabolic syndrome, participants with 2, 3, 4, and 5 components of chronic kidney disease had multivariate-adjusted odds ratios of 2.21 (CI, 1.16 to 4.24), 3.38 (CI, 1.48 to 7.69), 4.23 (CI, 2.06 to 8.63), and 5.85 (CI, 3.11 to 11.0), respectively. The corresponding multivariate-adjusted odds ratios of microalbuminuria for participants with 3, 4, and 5 components were 1.62 (CI, 1.10 to 2.38), 2.45 (CI, 1.55 to 3.85), and 3.19 (CI, 1.96 to 5.19), respectively. These findings suggest that the metabolic syndrome might be an important factor in the cause of chronic kidney disease.Annals of internal medicine 03/2004; 140(3):167-74. · 13.98 Impact Factor
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ABSTRACT: The clustering of impaired glucose metabolism, elevated triglycerides, low HDL cholesterol, and abdominal obesity is known as the metabolic syndrome. Individuals with this syndrome suffer an excess of cardiovascular disease (CVD) for reasons that are unclear. We randomly sampled 1276 adults of South Asian, Chinese, European, and Native Indian ancestry from 4 communities in Canada. Participants provided fasting blood samples for glucose, lipids, and fibrinolytic measurements; had an oral glucose tolerance test; and underwent a B-mode carotid ultrasound examination. CVD was determined by history and ECG. The prevalence of the metabolic syndrome was 25.8% (95% CI, 23.5 to 28.2) and varied substantially by ethnic group: 41.6% among Native Indians, 25.9% among South Asians, and 22.0% among Europeans, compared with 11.0% among the Chinese (overall, P=0.0001). People with the metabolic syndrome had more atherosclerosis (maximum intimal medial thickness, 0.78+/-0.18 versus 0.74+/-0.18 mm; P=0.0005), CVD (17.2% versus 7.0%; P=0.0001), and elevated plasminogen activator inhibitor-1 (24.2 versus 14.6 U/mL; P=0.001) compared with levels among people without the metabolic syndrome. For the same amount of atherosclerosis, people with the metabolic syndrome had a greater prevalence of CVD, even among nondiabetic individuals. This difference in CVD prevalence among the groups was attenuated after adjustment for plasminogen activator inhibitor-1 levels, suggesting that fibrinolytic dysfunction mediates the increased risk of CVD in individuals with the metabolic syndrome. CVD among people with the metabolic syndrome is explained by their excess of atherosclerosis and impaired fibrinolysis. Interventions to prevent atherosclerosis progression and improve fibrinolytic function require evaluation in this high-risk group.Circulation 08/2003; 108(4):420-5. · 15.20 Impact Factor
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ABSTRACT: To explore the associations between the metabolic syndrome (MS) and chronic kidney disease (CKD) in patients admitted to our department. A total of 525 consecutive patients were included in this cross-sectional study. Body height, weight, waist circumference, biochemical and serum lipid profile were measured. An oral glucose tolerance test (OGTT) was performed in patients without diabetes. CKD was defined by creatinine-based estimates of glomerular filtration rate (eGFR). The MS was defined according to IDF (International Diabetes Federation) definition. (1) Serum creatinine (Cr) was significantly increased and the mean level of eGFR was significantly reduced in patients with MS compared to those without MS [Cr (93.81 +/- 31.06) micromol/L vs. (108.65 +/- 36.05) micromol/L, P < 0.001; eGFR (61.14 +/- 17.40) ml.min(-1).1.73 m(-2) vs. (73.64 +/- 17.03) ml.min(-1).1.73 m(-2), P < 0.001]. (2) eGFR decreased in proportion to increasing number of the MS components and was the lowest when patients had 5 components of the MS (P < 0.001). (3) Compared to patients without MS, the multivariate-adjusted (adjustment for age, sex, chronic heart failure and the use of ACEI or ARB medication) odds ration (95% CI) of CKD was 4.34 (95% CI: 2.77 - 6.81) in patients with MS. Compared to patients without any components or only with one component, the multivariate-adjusted odds ratios (95% CI) of CKD were 3.12 (1.41 - 6.89), 8.21 (3.78 - 17.82) and 14.72 (6.14 - 35.30) for those with 3, 4 and 5 components, respectively. In the multivariate models, elevated blood pressure, hyperglycemia, abdominal obesity and elevated triglycerides were significantly associated with an increased odds ratio (95% CI) of CKD, 1.75 (1.04 - 2.92), 1.98 (1.26 - 3.11), 2.42 (1.41 - 4.16) and 2.65 (1.68 - 4.19), respectively. There are positive associations between MS, its components and CKD. The risk of CKD increased in proportion to increased number of MS components. Elevated blood pressure, hyperglycemia, abdominal obesity and hypertriglyceridemia also increase the risk of CKD.Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 07/2008; 36(7):618-22.