Aggravation of albuminuria by metabolic syndrome in type 2 diabetic Asian subjects

Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: Evidence from a meta-analysis on 10,603,067 subjects from 57 studies

BACKGROUND & AIM

Previous studies have explored the relation of metabolic syndrome (MetS), its components and the risk of albuminuria/proteinuria but their results are inconsistent. Then, we aimed to conduct a meta-analysis in order to resolve these controversies.

METHOD

PubMed and Scopus were systematically searched from their inception to 1 march 2018. Risk estimates and their 95% confidence intervals were extracted and pooled using the random-effects approach.

RESULT

A total of 57 studies, 44 studies on albuminuria and 13 studies on proteinuria, with a total sample size of 10,603,067 participants, were included in this meta-analysis. Overall, MetS was contributed to higher risks of proteinuria (OR = 2.08, 95%CI = 1.85-2.34) and albuminuria (OR = 1.92, 95%CI = 1.71-2.15), independent of diabetes status; although, this relationship was more noticeable in studies that used the WHO definition of MetS and in non-East Asian populations. Also, the relationship between MetS and proteinuria was sex independent, while, for albuminuria was significant only in men. MetS components such as obesity, impaired fasting glucose, elevated blood pressure and hypertriglyceridemia were associated with significant increases in proteinuria and albuminuria risk, while lower HDL-Cholesterol was only linked to greater risk of proteinuria. Moreover, the total impact of MetS on proteinuria was more remarkable than each component of the syndrome and an escalating dose-response association was found between the number of MetS components and albuminuria risk.

CONCLUSION

MetS and its components are potential risk factors for albuminuria and proteinuria.

Metabolic Syndrome without Diabetes or Hypertension Still Necessitates Early Screening for Chronic Kidney Disease: Information from a Chinese National Cross-Sectional Study

Metabolic syndrome (MS) is prevalent, with an increasing contribution to the incidence of chronic kidney disease (CKD). The study of the relationship between them is important. The CKD survey, a national cross-sectional study, provided a large database to accomplish this study. The study population were 41 131 adults from this survey between 2008 and 2009. CKD was defined as estimate glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 or the presence of albuminuria. MS was diagnosed by National Cholesterol Education Program-Adult Treatment Panel III (ATPIII), ATPIII-modified or International Diabetes Federation (IDF) criteria. Logistic regression model was applied to study the impact of MS or its components on CKD or its components. The age and sex standardized prevalence of MS by ATPIII, ATPIII-modified and IDF criteria was 11.77% (11.13%-12.40%), 21.51% (20.69%-22.34%) and 16.67% (15.92-17.42)% respectively. Multivariate logistic regression models showed that MS and its components were associated with higher CKD prevalence. The risk for CKD and its components increased with the number of MS components. After adjusting for hypertension and diabetes, the odds ratios of MS for CKD decreased, but remained significantly more than 1 between 1.16(95%CI 1.07-1.26) and 1.37 (95% CI 1.25-1.50) across the different models. Similar results were found with albuminuria, while for decreased eGFR, after adjusting for hypertension and diabetes, the odds ratios of MS and MS components (except elevated TG) became insignificant. In conclusion, MS is prevalent and associated with a higher prevalence of CKD. Different MS components are associated with different risks for CKD, even after adjusting for hypertension and diabetes, which may mainly be contributed more by the increased risk for albuminuria than that for decreased eGFR. More attention must be paid to the population with MS, including those with elevated blood pressure and serum glucose.

Chronic Kidney Disease—Effect of Oxidative Stress

Chronic kidney disease (CKD) is a growing health problem with increasing incidence. The annual mortality of end-stage renal disease patients is about 9%, which is 10–20 fold higher than the general population, approximately 50% of these deaths are due to cardiovascular (CV) disease. CV risk factors, such as diabetes, hypertension, and hyperlipidemia, are strongly associated with poor outcome. Many other nontraditional risk factors such as inflammation, infection, oxidative stress, anemia, and malnutrition are also present. In this review we will focus on the role of oxidative stress in chronic kidney disease.

High triglyceride-to-HDL cholesterol ratio associated with albuminuria in type 2 diabetic subjects

OBJECTIVE

Emerging evidence indicates that metabolic syndrome (MetS) predisposes diabetic subjects to nephropathy. Aside from hypertension and hyperglycemia, it is unclear which component of MetS also contributes to increased urinary albumin excretion (UAE). We compared the MetS profiles of subjects divided into two groups based on their UAE.

METHODS

The Asia Pacific Real-Life Effectiveness and Care Patterns of Diabetes Management (AP RECAP-DM) study is a cross-sectional survey in which type 2 diabetic subjects using oral anti-hyperglycemic drugs were enrolled. We analyzed the data of 162 type 2 diabetic subjects with normotension or taking antihypertensive medications.

RESULTS

There were 123 subjects with normal UAE (<30 mg/g) and 39 with abnormal UAE (≥30 mg/g). MetS was more prevalent in the abnormal UAE group (79.5%) than in the normal UAE group (58.5%) (P=0.018). Hypertriglyceridemia (odds ratio=8.65, P<0.001) and reduced high-density lipoprotein (HDL) cholesterol (odds ratio=3.27, P=0.022) were both independently associated with abnormal UAE. Using 3.4 as a cut-off value, a high triglyceride-to-HDL cholesterol ratio was a useful marker (odds ratio=15.05, P<0.001) for abnormal UAE.

CONCLUSIONS

A high triglyceride-to-HDL cholesterol ratio was found to be an important risk factor for nephropathy in type 2 diabetic subjects.

Metabolic syndrome and renal injury

Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are major global health issues. Current clinical markers used to reflect renal injury include albuminuria and estimated glomerular filtration rate (eGFR). Given the same eGFR level, urine albumin might be a better risk marker to predict progression of CKD and future development of cardiovascular diseases (CVDs). Serum Cystatin C is emerging as a new biomarker for early detection of renal injury associated with MetS and cardiovascular risk. In addition to each component, MetS per se influences the incidence and prognosis of renal injury and the odds ratios increased with the increase in the number of metabolic abnormalities. Hyperinsulinemia, activation of rennin-angiotensin-aldosterone system, increase of oxidative stress, and inflammatory cytokines are proposed to be the plausible biological link between MetS and CKD. Weight control, stick control of blood pressure, glucose, and lipids disorders may lead to lessening renal injury and even the subsequent CVD.

Metabolic syndrome is independently associated with microalbuminuria in type 2 diabetes

We opted in this study to evaluate the association between metabolic syndrome (MetS) and microalbuminuria in type 2 diabetes. A total of 800 adults (344 males; age 54.8 +/- 9.6 years) with type 2 diabetes were studied. MetS was defined by the International Diabetes Federation criteria and microalbuminuria by urinary albumin excretion between 30 and 299 mg/day on at least two of three occasions. Patients with macroalbuminuria and those with poor renal function were not included. Microalbuminuria was present in 237 (29.6%) patients with MetS and increased in prevalence with increasing numbers of metabolic abnormalities (P < 0.001). The normo- and micro-albuminuric groups were not significantly different in age, sex, and renal function. However, MetS was significantly more common among patients with (90.3%) than those without (76.6%) microalbuminuria (P < 0.01). In multivariate regression, MetS was the strongest correlate of microalbuminuria (OR = 3.31, 95% CI = 1.91-5.75; P < 0.01). In conclusion, MetS is independently associated with microalbuminuria in type 2 diabetes.

Placental weight and birthweight: does the association differ between pregnancies with and without preeclampsia?

OBJECTIVE

Placental weight and infant birthweight may be markers of different types of preeclampsia. We studied birthweight within placental weight percentiles in pregnancies with and without preeclampsia.

STUDY DESIGN

This was a population study of 317,688 singleton births.

RESULTS

Within the lowest 10% of placental weight, 36% of the offspring were small for gestational age (SGA) in preeclamptic pregnancies and 14% in normotensive pregnancies (relative risk, 2.6; 95% confidence interval, 2.4-2.8). Risk of SGA subsided with increasing placental weight and was negligible at >50th percentile. At low placental weights, large for gestational age (LGA) offspring were nearly nonexistent; however, at >70th percentile, LGA occurred more often in pregnancies with preeclampsia. Within the highest 10% of placental weight, 20.7% of the infants were LGA in the preeclampsia group, and 15.3% of the infants were LGA in pregnancies without preeclampsia (relative risk, 1.4; 95% confidence interval, 1.2-1.5).

CONCLUSION

In pregnancies with small placentas, the offspring were more often SGA in preeclamptic pregnancies and more often LGA at high placental weights. The results support the hypothesis that preeclampsia may represent different diseases, depending on placental size and infant birthweight.