Metabolic Syndrome Is Associated With Rapid Estimated Glomerular Filtration Rate Decline In A Chinese Community-Based Population

The Effect of Metabolic Syndrome and Its Individual Components on Renal Function: A Meta-Analysis

BACKGROUND

Observational studies have reported inconsistent findings in the relationship between metabolic syndrome (MetS), its components, and loss of renal function, mainly including eGFR decline, new-onset CKD, and ESRD. This meta-analysis was performed to investigate their potential associations.

METHODS

PubMed and EMBASE were systematically searched from their inception to 21 July 2022. Observational cohort studies in English assessing the risk of renal dysfunction in individuals with MetS were identified. Risk estimates and their 95% confidence intervals (CIs) were extracted and pooled using the random-effects approach.

RESULTS

A total of 32 studies with 413,621 participants were included in the meta-analysis. MetS contributed to higher risks of renal dysfunction (RR = 1.50, 95% CI = 1.39-1.61) and, specifically, rapid decline in eGFR (RR 1.31, 95% CI 1.13-1.51), new-onset CKD (RR 1.47, 95% CI 1.37-1.58), as well as ESRD (RR 1.55, 95% CI 1.08-2.22). Moreover, all individual components of MetS were significantly associated with renal dysfunction, while elevated BP conveyed the highest risk (RR = 1.37, 95% CI = 1.29-1.46), impaired fasting glucose with the lowest and diabetic-dependent risk (RR = 1.20, 95% CI = 1.09-1.33).

CONCLUSIONS

Individuals with MetS and its components are at higher risk of renal dysfunction.

High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1-4: The ICKD database

AIMS

To investigate whether metabolic syndrome (MetS) could predict renal outcome in patients with established chronic kidney disease (CKD).

MATERIALS AND METHODS

We enroled 2500 patients with CKD stage 1-4 from the Integrated CKD care programme, Kaohsiung for delaying Dialysis (ICKD) prospective observational study. 66.9% and 49.2% patients had MetS and diabetes (DM), respectively. We accessed three clinical outcomes, including all-cause mortality, RRT, and 50% decline in estimated glomerular filtration rate events.

RESULTS

The MetS score was positively associated with proteinuria, inflammation, and nutrition markers. In fully adjusted Cox regression, the hazard ratio (HR) (95% confidence interval) of MetS for composite renal outcome (renal replacement therapy, and 50% decline of renal function) in the DM and non-DM subgroups was 1.56 (1.15-2.12) and 1.31 (1.02-1.70), respectively, while that for all-cause mortality was 1.00 (0.71-1.40) and 1.27 (0.92-1.74). Blood pressure is the most important component of MetS for renal outcomes. In the 2 by 2 matrix, compared with the non-DM/non-MetS group, the DM/MetS group (HR: 1.62 (1.31-2.02)) and the non-DM/MetS group (HR: 1.33 (1.05-1.69)) had higher risks for composite renal outcome, whereas the DM/MetS group had higher risk for all-cause mortality (HR: 1.43 (1.09-1.88)).

CONCLUSIONS

MetS could predict renal outcome in patients with CKD stage 1-4 independent of DM.

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.

Malnutrition Risk and Kidney Function and Decline in Community-Dwelling Older Adults

OBJECTIVES

The association of malnutrition with chronic kidney disease (CKD) is well established. However, there is a paucity of studies of the effect of malnutrition risk (MR) on kidney function decline among older persons who do not have end-stage or dialyzable CKD. This study aimed to examine the association between MR status and kidney function, and future risks of kidney function decline and CKD progression in community-dwelling older adults.

DESIGN AND METHODS

Nutrition Screening Initiative's DETERMINE Your Nutritional Health Checklist and estimated glomerular filtration rate (eGFR) were assessed at baseline among 5,122 participants free of end-stage renal failure or dialyzed CKD in the Singapore Longitudinal Aging Studies (SLAS-1 and SLAS-2). Follow-up eGFR was assessed in a subcohort of SLAS-2 participants without CKD (eGFR > 60 mL/min/1.73 m²) at baseline (N = 786) who were followed up at 3-5 years.

RESULTS

In baseline cross-sectional analyses adjusting for other risk factors, low, moderate, and high MR was significantly associated with decreasing eGFR coefficients of -1.5, -3.3, and -5.0 mL/min/1.73 m² respectively, and increasing CKD odds ratios of 1.81, 2.18, and 3.11 respectively. In longitudinal analysis, low, moderate, and high MR was significantly associated with increased risk of eGFR (>25%) decline (odds ratio of 2.37, 3.34, and 2.18 respectively).

CONCLUSIONS

Among older adults without advanced kidney disease, MR is associated with poor kidney function and increased risk of kidney function decline and CKD. Preventive interventions to modify MR may help to reduce the deterioration of renal function in older people.

Prevalence and associations of metabolic syndrome in patients with alcohol use disorder

Excessive alcohol consumption has been associated with different components of the metabolic syndrome (MetS) such as arterial hypertension, dyslipidemia, type 2 diabetes or obesity. We aimed to analyze the prevalence and associations of MetS in patients with Alcohol Use Disorder (AUD). Cross-sectional study in heavy drinkers admitted for the treatment of AUD between 2013 and 2017. Medical comorbidity, anthropometric data, alcohol use and biological parameters were obtained. MetS was established according to the harmonized definition. A total of 728 patients (22% women) were included; median age was 47 years (IQR: 40–53.5), median alcohol consumption was 160 g/day (IQR: 115–240) and prevalence of MetS was 13.9%. The multivariate analysis showed a significant dose–response effect of estimated glomerular filtration (eGFR) and MetS: relative to patients with eGFR > 90 mL/min, those with eGFR (60–90 mL/min) and those with eGFR < 60 mL/min were 1.93 times (95% CI 1.18–3.15) and 5.61 times (95% CI 1.66–19.0) more likely to have MetS, respectively. MetS was significantly associated with hyperuricemia (OR 2.28, 95% CI 1.36–3.82) and elevated serum GGT (OR 3.67, 95% CI 1.80–7.46). Furthermore, for every increase of 1 year in age, the probability of MetS increased significantly (OR 1.03, 95% CI 1.01–1.05). MetS in heavy drinkers is independently associated with reduced kidney function and metabolic risk factors including hyperuricemia and elevated serum GGT.

Association between metabolic syndrome and incident chronic kidney disease among Chinese: A nation-wide cohort study and updated meta-analysis

AIMS

We prospectively examined the relationship between metabolic syndrome (MetS) and incident chronic kidney disease (CKD) among middle-aged and elderly Chinese, and conducted a systematic review and meta-analysis of all cohort studies on this topic.

MATERIALS AND METHODS

Our research data were derived from the China Health and Retirement Longitudinal Study. Participants (n=5752, age ≥45 years) without CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73m² ) at baseline were followed up for 4 years. We applied logistic regressions to examine the association of MetS with incident CKD. In addition, we pooled our effect estimates and those from previous cohort studies in the meta-analysis.

RESULTS

In a 4-years follow-up, 61 (4.27%) developed CKD in participants with MetS versus 102 (2.36%) in participants without MetS. After adjustment for potential confounders, odds ratio for incident CKD was 1.82 [95% confidence interval (95% CI): 1.19-2.78] comparing participants with MetS with those without MetS. There was a linear positive association between the number of MetS components and incident CKD (p for trend <0.001). In the updated meta-analysis of 25 studies among 350,655 participants with 29,368 incident cases of CKD, the pooled relative risk of developing CKD in participants with MetS was 1.34 (95% CI: 1.28-1.39), compared with those without MetS.

CONCLUSIONS

Individuals with MetS had higher risk of incident CKD in middle-aged and elderly Chinese adults, which was supported by a comprehensive review of cohort studies from multiple populations. It may be advisable to routinely monitor renal functions among individuals with MetS.

Efficacy of Additional Intervention to the Specific Health Guidance in Japan: The Takahata GENKI Project

Purpose

A tailored approach to individual risk factors for developing lifestyle-related diseases would help induce behavioral changes toward intervention acceptability. The addition of preventive healthcare programs to nationwide specific health guidance in Japan is adapted in a given region.

Patients and Methods

We conducted a prospective parallel-group comparison study on 195 eligible residents from Takahata, Japan, with a high risk of lifestyle-related diseases from 2014 to 2017 to examine whether such an intervention could improve the body mass index (BMI) and estimated glomerular filtration rate (eGFR).

Results

Of the 195 enrolled residents, 117 were assigned to the control group and 78 to the intervention group. They were ≤65 years old and had a BMI ≥25 kg/m² and an eGFR ≤90 mL/kg/1.73 m². We conducted certain interventions for each group, including additional blood testing, regular health guidance, and specific health guidance. After one year, neither BMI (intervention: 26.7 ± 2.17 kg/m² vs control: 27.3 ± 2.12 kg/m², p = 0.076) nor eGFR (intervention: 72.2 ± 11.1 mL/kg/1.73 m² vs control: 73.1 ± 10.5 mL/kg/1.73 m², p = 0.608) differed significantly between groups. However, after three years, the BMI in the intervention group (26.4 ± 2.05 kg/m²) was significantly reduced compared to that in the control group (27.4 ± 2.26 kg/m²; p = 0.005).

Conclusion

The additional interventions might have contributed to a reduction in metabolic syndrome.

Trial Registration

This study was registered in the UMIN-Clinical Trials Registry (ID:000013581). More information: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000015868. The registration date was 31/03/2014.

The effect of triglycerides to high-density lipoprotein cholesterol ratio on the reduction of renal function: findings from China health and retirement longitudinal study (CHARLS)

BACKGROUND

Previous studies show that abnormal lipoprotein metabolism can increase the prevalence of chronic kidney disease (CKD). This study prospectively investigated the association of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and renal dysfunction in the Chinese population.

METHODS

This longitudinal cohort research examined 7,316 participants (age range: 22-93) from the China Health and Retirement Longitudinal Study (CHARLS), including 6,560 individuals with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (normal renal function, NRF) group and 756 with eGFR < 60 mL/min/1.73 m2 (impaired renal function, IRF) group. In NRF group, reduction in renal function was defined as eGFR < 60 mL/min/1.73 m2 at exit visit and in IRF group, it was defined as decline in eGFR category, average eGFR decline > 5 mL/min/1.73 m2 per year or > 30 % decrease in eGFR from baseline.

RESULTS

The study results showed that TG/HDL-C ratio was positively associated with the risk of renal function decline in the NRF group (OR 1.30, 95 %CI 1.03-1.65, P = 0.03) and the IRF group (OR 1.90, 95 %CI 1.21-3.23, P = 0.02) when adjusting for age, gender, obesity, diabetes, hypertension, waist circumference, drinking, smoking, history of heart disease and stroke, low-density lipoprotein cholesterol and eGFR category. Analysis of the IRF group indicated that relative to the group of TG/HDL-C < 1.60, the group of TG/HDL-C ≥ 2.97 had an increased risk for the decline of eGFR category (OR 1.89, 95 %CI 1.12-3.21, P = 0.02) and > 30 % decline in eGFR (OR 2.56, 95 %CI 1.05-6.38, P = 0.04).

CONCLUSIONS

The high TG/HDL-C ratio was an independent risk factor for declining renal function in the Chinese population.

Association between kidney function, nutritional status and anthropometric measures in older people : The Screening for CKD among Older People across Europe (SCOPE) study

BACKGROUND

Different mechanisms connect the nutritional status with the occurrence and the course of chronic kidney disease (CKD). The end-stage renal disease is complicated by catabolic inflammatory reactions and cachexia which leads to malnutrition (undernutrition). On the other hand, obesity is an important risk factor for the development and acceleration of CKD.

METHODS

In the SCOPE study, community-dwelling persons aged 75 years and over, from 6 European countries and Israel were examined at the baseline phase. We assessed the relationship between anthropometric measures (Body Mass Index (BMI), circumferences of arm (AC), waist (WC), hip (HC), and calf (CC), waist-to-hip ratio - WHR, waist-to-height ratio - WHtR, risk of malnutrition (Mini Nutritional Assessment - MNA), serum albumin) and estimated glomerular filtration rate (eGFR) calculated by Berlin Initiative Study (BIS) equation.

RESULTS

We studied 2151 subjects (932 men and 1219 women) with a mean age of 79.5 ± 5.9 years. A total of 1333 (62%) participants had CKD (GRF < 60 ml/min/1.73 m²). Negative correlations between eGFR and weight, AC, WC, HC, CC, BMI, WHtR were observed. Positive correlation occurred between eGFR and MNA score (Spearman's rho = 0.11) and albumin concentration (rho = 0.09). Higher weight, AC, WC, HC, CC, BMI and WHtR increased the odds ratio of CKD; higher MNA (OR = 0.98, 95% CI 0.94-1.0) and higher serum albumin (OR = 0.73, 95% CI 0.53-1.0) were weakly associated with reduced odds. The risk of malnutrition was the highest with eGFR < 30 as compared to eGFR > 60 (OR = 2.95, 95%CI = 1.77-4.94 for MNA < 24; OR = 5.54, 95%CI = 1.66-18.5 for hypoalbuminemia < 3.5 g/dL).

CONCLUSION

The population of community dwelling people aged 75+ with CKD shows general features of overweight and obesity with a small prevalence of malnutrition. For anthropometric measures, the strongest association with eGFR and the highest odds of CKD were identified using WC, HC, CC and WHtR. Albumin level and MNA, but not MNA Short Form, indicated an increased odds of malnutrition with a decrease in eGFR.