Metabolic syndrome is a predictor of decreased renal function among community-dwelling middle-aged and elderly Japanese

PurposeMetabolic syndrome (MetS) is increasing worldwide with the continuous increase in obesity prevalence. Chronic kidney disease (CKD) is also a major public health problem, but there is controversy over whether baseline MetS is a predictor of decreased renal function among Japanese community-dwelling middle-aged and elderly Japanese.MethodsWe conducted a prospective cohort study designed as part of the Nomura study. We recruited a random sample of 410 men aged 688 (meanstandard deviation; range, 50-95) years and 549 women aged 69 +/- 7 (50-84) years during their annual health examination in a single community. We examined the relationship between baseline MetS and renal dysfunction after a 3-year evaluation based on estimated glomerular filtration rate (eGFR(CKDEPI)) using the CKD-EPI equations modified by the Japan coefficient. CKD was defined as dipstick-positive proteinuria (>or=1+) or a low eGFR(CKDEPI) (<60 mL/min/1.73 m(2)).Results Of the 959 participants, 413 (43.1%) had MetS at baseline. Annual eGFR decline rate was significantly greater in those with MetS than in those without MetS, and the annual eGFR decline rate of<-1.2 mL/min/1.73 m(2)/year increased significantly in relation to presence of baseline MetS, especially low HDL cholesterol (HDL-C). Moreover, the incidence rate of CKD after 3 years was 13.5% and increased significantly in relation to presence of baseline MetS, especially its components such as elevated HbA1c. The multivariate-adjusted odd ratio (OR) for CKD in participants with MetS versus those without MetS was 1.55 (0.99-2.43). The multivariate-adjusted ORs for rapid annual eGFR decline rate were significantly high in patients aged >= 65 years and presence of medication, regardless of gender and eGFR value.Conclusions Low HDL-C and elevated HbA1c levels correlated significantly with eGFR decline in a short period of 3 years. MetS also showed a significant association with eGFR decline. This study suggests the importance of low HDL-C and elevated HbA1c in the effect of MetS on eGFR decline rather than obesity among Japanese community-dwelling middle-aged and elderly Japanese without CKD.