Association of Metabolic Syndrome in Nondiabetic Patients with Increased Risk for Chronic Kidney Disease: The Fat Lady Sings

Overweight and obesity cause pathophysiological changes in renal function and increase the risk for chronic kidney disease in otherwise healthy subjects. This should not be a surprise as the risk factors for metabolic syndrome largely overlap with those for chronic kidney disease. Intentional weight loss has beneficial effects on risk factors, but long term effects are less clear. Bariatric surgery does seem to achieve rapid benefits on blood pressure and proteinuria as well as on other aspects of metabolic syndrome, but its long term implications for kidney function are less clear cut as there may be an increased risk of nephrolithiasis, and possibly AKI and other complications.Obesity in haemodialysis patients is one of those paradoxical examples of reverse epidemiology where a factor associated with negative outcomes in the general population is associated with better outcomes in dialysis patients. The same is true for high blood cholesterol values. Interpretation is complicated by complex competing outcomes and confounders.

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Metabolic Syndrome and Outcomes after Renal Intervention

Cardiology Research and Practice ◽

10.4061/2011/781035 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Daynene Vykoukal ◽

Mark G. Davies

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Observational Studies ◽

Dialysis Access ◽

Fasting Insulin ◽

Prothrombotic State ◽

Atherosclerotic Renal Artery Stenosis ◽

Increased Risk

Metabolic syndrome significantly increases the risk for cardiovascular disease and chronic kidney disease. The increased risk for cardiovascular diseases can partly be caused by a prothrombotic state that exists because of abdominal obesity. Multiple observational studies have consistently shown that increased body mass index as well as insulin resistance and increased fasting insulin levels is associated with chronic kidney disease, even after adjustment for related disorders. Metabolic syndrome appears to be a risk factor for chronic kidney disease, likely due to the combination of dysglycemia and high blood pressure. Metabolic syndrome is associated with markedly reduced renal clinical benefit and increased progression to hemodialysis following endovascular intervention for atherosclerotic renal artery stenosis. Metabolic syndrome is associated with inferior early outcomes for dialysis access procedures.

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25-hydroxyvitamin D deficiency is associated with an increased risk of metabolic syndrome in patients with non-diabetic chronic kidney disease

Clinical Nephrology ◽

10.5414/cn107498 ◽

2012 ◽

Vol 78 (12) ◽

pp. 432-441 ◽

Cited By ~ 2

Author(s):

Stephanie Seiki ◽

Michel Chonchol ◽

Alfred K. Cheung ◽

James S. Kaufman ◽

Tom Greene ◽

...

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Hydroxyvitamin D ◽

Increased Risk ◽

25 Hydroxyvitamin D

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Obstructive spirometry pattern and the risk of chronic kidney disease: analysis from the community-based prospective Ansan-Ansung cohort in Korea

BMJ Open ◽

10.1136/bmjopen-2020-043432 ◽

2021 ◽

Vol 11 (3) ◽

pp. e043432

Author(s):

Sang Hyuk Kim ◽

Hyeon Sam Kim ◽

Hyang Ki Min ◽

Sung Woo Lee

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Large Scale ◽

Forced Expiratory Volume ◽

Community Based ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

Cubic Spline Curve

ObjectiveThere have been limited studies on the relationship between obstructive spirometry pattern and the development of chronic kidney disease (CKD). We investigated the association between obstructive spirometry pattern and incident CKD development in a large-scale prospective cohort study.MethodsWe reviewed the data of 7960 non-CKD adults aged 40–69 years who participated in the Ansung-Ansan cohort, a prospective community-based cohort study. Prebronchodilation results for the ratio of forced expiratory volume per 1 s (FEV1) to forced vital capacity (FVC) were used as the primary exposure. The primary outcome was incident CKD, defined as the first event of an estimated glomerular filtration rate <60 mL/min/1.73 m2. HRs and 95% CIs were calculated using multivariate Cox proportional hazard regression analysis.ResultsOver a mean follow-up period of 11.7 years, incident CKD developed in 511 subjects (6.4%). An increase of 0.1 in FEV1/FVC was associated with a decreased risk of incident CKD (HR 0.76, 95% CI 0.68 to 0.84, p<0.001). Compared with the fourth quartile, the HR (95 % CI) of the first quartile of FEV1/FVC ratio was 1.81 (1.39 to 2.36, p<0.001). In the restricted cubic spline curve, the renal hazard associated with a decreased FEV1/FVC ratio was evident at FEV1/FVC values <0.80, showing a U-shaped relationship. In subgroup analysis, the renal hazard associated with a decreased FEV1/FVC ratio was particularly evident in people without metabolic syndrome (p for interaction=0.018).ConclusionDecreased FEV1/FVC ratio was independently associated with an increased risk of incident CKD development, particularly in people without metabolic syndrome. Future studies need to be conducted to confirm these results.

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The NCEP-ATPIII but not the IDF criteria for the metabolic syndrome identify Type 2 diabetic patients at increased risk of chronic kidney disease

Diabetic Medicine ◽

10.1111/j.1464-5491.2008.02602.x ◽

2008 ◽

Vol 25 (12) ◽

pp. 1419-1425 ◽

Cited By ~ 17

Author(s):

A. O. Y. Luk ◽

R. C. W. Ma ◽

W-Y. So ◽

X-L. Yang ◽

A. P. S. Kong ◽

...

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

The Metabolic Syndrome ◽

Increased Risk ◽

Type 2 Diabetic

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Metabolic Syndrome, and Not Obesity, Is Associated with Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000518111 ◽

2021 ◽

Vol 52 (8) ◽

pp. 666-672

Author(s):

Stefano Ciardullo ◽

Cinzia Ballabeni ◽

Roberto Trevisan ◽

Gianluca Perseghin

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Elevated Blood ◽

Sectional Study ◽

Cross Sectional ◽

Urine Albumin ◽

Increased Risk

Introduction: Obese (OB) patients are at increased risk of chronic kidney disease, but it is still unclear whether this can be attributed to obesity per se or to the associated metabolic derangements. The aim of this study was to evaluate the relative impact of obesity and metabolic syndrome (MS) on kidney disease. Methods: This is a cross-sectional study based on data obtained in the 2005–2016 cycles of the National Health and Nutrition Examination Survey. We included all adult participants with available data on body mass index, estimated glomerular filtration rate (eGFR), urine albumin to creatinine ratio (UACR), and each of the MS components. Primary outcomes were eGFR <60 mL/min, UACR ≥30 mg/g, or a combination of the two. Results: The studied population comprised 12,335 participants. OB participants without MS (OB+ MS−) were younger and more commonly female. After adjustment for potential confounders, compared with OB− MS− participants, an increased prevalence of albuminuria and reduced eGFR were present in both OB− MS+ groups and the OB+ MS+ groups, but not in the OB+ MS− groups. When each of the MS components was evaluated separately, elevated blood pressure and low high-density lipoprotein cholesterol were associated with both UACR and reduced eGFR, while elevated blood glucose and triglycerides were only associated with UACR. Waist circumference was not associated with any of the renal outcomes. Discussion/Conclusion: This large cross-sectional study suggests that MS and not obesity is associated with kidney damage and that the OB+ MS− phenotype does not seem to carry an increased risk of kidney disease.

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Insulin Resistance in Patients with Chronic Kidney Disease

Journal of Biomedicine and Biotechnology ◽

10.1155/2012/691369 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 31

Author(s):

Min-Tser Liao ◽

Chih-Chien Sung ◽

Kuo-Chin Hung ◽

Chia-Chao Wu ◽

Lan Lo ◽

...

Keyword(s):

Oxidative Stress ◽

Insulin Resistance ◽

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Elevated Serum ◽

Cytokine Signaling ◽

Protein Energy Wasting ◽

The Metabolic Syndrome ◽

Increased Risk

Metabolic syndrome and its components are associated with chronic kidney disease (CKD) development. Insulin resistance (IR) plays a central role in the metabolic syndrome and is associated with increased risk for CKD in nondiabetic patients. IR is common in patients with mild-to-moderate stage CKD, even when the glomerular filtration rate is within the normal range. IR, along with oxidative stress and inflammation, also promotes kidney disease. In patients with end stage renal disease, IR is an independent predictor of cardiovascular disease and is linked to protein energy wasting and malnutrition. Systemic inflammation, oxidative stress, elevated serum adipokines and fetuin-A, metabolic acidosis, vitamin D deficiency, depressed serum erythropoietin, endoplasmic reticulum stress, and suppressors of cytokine signaling all cause IR by suppressing insulin receptor-PI3K-Akt pathways in CKD. In addition to adequate renal replacement therapy and correction of uremia-associated factors, thiazolidinedione, ghrelin, protein restriction, and keto-acid supplementation are therapeutic options. Weight control, reduced daily prednisolone dosage, and the use of cyclosporin decrease the risk of developing new-onset diabetes after kidney transplantation. Improved understanding of the pathogenic mechanisms underlying IR in CKD may lead to more effective therapeutic strategies to reduce uremia-associated morbidity and mortality.

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Metabolic Syndrome May Affect Chronic Kidney Disease

Internal Medicine News ◽

10.1016/s1097-8690(07)70040-9 ◽

2007 ◽

Vol 40 (2) ◽

pp. 30

Keyword(s):

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease

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Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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