Metabolic Syndrome and Chronic Kidney Disease
Metabolic syndrome and chronic kidney disease (CKD) have become global public health problems due to their increasing prevalence and their close associations with cardiovascular events. First recognised by Reavenin 1988, metabolic syndrome (previously known as syndrome X) is a complex pathophysiological issue and essentially considered as an assembly of cardiovascular and metabolic risk factors, which include abdominal obesity, dyslipidaemia, hypertension and insulin resistance/ hyperglycaemia components. Over the years, there have been several definitions of metabolic syndrome. In most of the epidemiological studies NCEP-ATP (National Cholesterol Education Program-Adult Treatment Panel III) criteria were used.
Lastly, Harmonized (Consensus) Definition incorporating IDF (International Diabetes Federation) and AHA/NHLB (American Heart Association/ National Heart, Lung and Blood Institute) definitions were released requiring any three of the following criteria:
- Waist circumference for Europids >94 cm in men and >80 cm in women,
- Triglycerides ≥ 150 mg/dL,
- HDL cholesterol
- Blood presssure ≥ 130 mmHg systolic ;
- ≥ 85 mmHg diastolic,
- Fasting glucose ≥ 100 mg/dL or use of medication
The frequency of metabolic syndrome is approximately 20-25% of adult population, showing some difference according to race, gender and geographical regions. The frequency of metabolic syndrome is alarmingly high and reaching 50% in obese population. This is especially important in this century, because there is a global epidemic of obesity in developed and emerging economies driven by easy access to high calorie food and sedentary life style. Several studies have shown a clear association between metabolic syndrome and markers of CKD, including reduced glomerular filtration rate, proteinuria, and micro albuminuria.
In most of the studies, presence of hypertension and diabetes were the prominent risk factors leading to CKD, at the setting of metabolic syndrome. It was also suggested that as the number of metabolic syndrome components increased, the risk for CKD increased more, especially for those who fulfilled three or more criteria.
A meta-analysis including more than thirty thousand people reported that metabolic syndrome was associated with development of an estimated GFR for stage 3 CKD level with odds ratio 1.55, even when diabetes was excluded. Another study including more than seven thousand people that were followed for twenty-one years have shown that those with normal renal function at baseline had an odds ratio of 2.6 for CKD if metabolic syndrome was present.
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Clinical Nephrology and Research