Associations of body size with metabolic syndrome and mortality in moderate chronic kidney disease.
ABSTRACT Obesity is associated with metabolic syndrome and poor outcomes in those with normal kidney function but better survival in dialysis patients. We examined whether chronic kidney disease (CKD) modifies the association of obesity with metabolic syndrome and mortality.
Analyses of 15,355 participants in limited access, public use Atherosclerosis Risk in Communities Study database.
The prevalence of metabolic syndrome in (BMI) groups < 20, 20 to 24.9, 25 to 29.9, 30 to 34.9, and > or = 35 kg/m2 were 1, 6, 17, 28, and 35% and 9, 15, 32, 46, and 58% in participants without (n = 14,894) and with CKD (n = 461), respectively. Using BMI 20 to 24.9 kg/m2 as the reference, there was a U-shaped association of BMI with mortality in a parametric survival model of death. An interaction term of BMI and CKD added to the model was significant. In participants with (BMI) > or = 25 kg/m2, each 1-kg/m2 increase in BMI was associated with increased hazard of death only in those without CKD. Adjustment for components of metabolic syndrome, markers of inflammation, and cardiovascular conditions abolished these associations in participants without CKD but became protective in participants with CKD.
The prevalence of obesity parallels metabolic syndrome in populations with and without CKD. However, the presence of CKD modifies the associations of obesity with mortality.
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ABSTRACT: The metabolic syndrome (MS), a cluster of cardiovascular risk factors closely linked to insulin resistance whose prevalence is high and rapidly rising in the Western population, has been recognized as a predictor of diabetes and future cardiovascular disease in the general population, as well as in various clinical settings. There is evidence that the MS increases cardiovascular risk, independently from the concomitant effect of several traditional cardiovascular risk factors. Emerging data suggest that MS might also be a risk factor for chronic kidney disease, although its effects on the emergence of chronic kidney disease or its progression beyond the contribution of dys-glycemia and high blood pressure are far from being established with certainty. The concept of the MS has been a topic of lively discussion, given its controversial pathogenesis and clinical usefulness, and several important conceptual and practical drawbacks in its definition raise questions regarding its utility as a risk stratification tool. Nevertheless, the definition of MS has gained wide popularity in the clinical arena as a simple, practical tool for identifying those patients with multiple metabolic risk factors associated with insulin resistance that impart an increased cardiovascular risk not adequately considered by the traditional cardiovascular risk factors. Identification of the MS may help clinicians to move away from a strategy based on single risk factors to one that focuses on multiple risk factors and may increase the awareness of both physicians and patients regarding the cardiovascular importance of targeting metabolic risk factors through weight reduction and exercise.Journal of nephrology 22(1):29-38. · 1.65 Impact Factor
Article: The prevalence of chronic kidney disease (CKD) and the associated factors to CKD in urban Korea: a population-based cross-sectional epidemiologic study.[show abstract] [hide abstract]
ABSTRACT: Chronic kidney disease (CKD) is a worldwide problem. This study was designed to survey the prevalence and risk factors for CKD in Korea. The 2,356 subjects were selected in proportion to age, gender, and city. Subjects 35 yr of age or older were selected from 7 cities. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) Study equation, with albuminuria defined as a urine albumin to creatinine ratio of 30 mg/g or more. The overall prevalence of CKD was 13.7%. The prevalences of CKD according to stage were 2.0% stage 1, 6.7% stage 2, 4.8% stage 3, 0.2% stage 4, and 0.0% stage 5. The prevalences of microalbuminuria and macroalbuminuria were 8.6% and 1.6%, respectively. The prevalence of eGFR less than 60 mL/min/1.73 m(2) was 5.0%. Age, body mass index (BMI), hypertension, diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose were independent factors related to the presence of CKD. In conclusions, Korea, in which the prevalence of CKD is increasing, should prepare a policy for early detection and appropriate treatment of CKD. The present data will be helpful in taking those actions.Journal of Korean Medical Science 02/2009; 24 Suppl:S11-21. · 0.99 Impact Factor
Chapter: Obesity and Kidney Transplantation09/2011; , ISBN: 978-953-307-819-9