Metabolic Syndrome, ESRD, and Death in CKD

Background and objectives Previous studies reported an association between metabolic syndrome, incident CKD, and proteinuria. This study examined the associations between metabolic syndrome and its components with ESRD and death among those patients with stages 3 and 4 CKD (estimated GFR=15-59 ml/min per 1.73 m(2)). Design, setting, participants, & measurements Patients with stages 3 and 4 CKD (n=25,868) who had data relating to metabolic syndrome and were followed in our health care system were identified using an electronic medical record-based registry. Cox proportional hazards models and competing risk analyses were used to study the associations between metabolic syndrome, its components (elevated BP, low HDL cholesterol, elevated serum triglycerides, impaired glucose metabolism, and obesity), and all-cause mortality and ESRD while adjusting for demographics, comorbid conditions, use of relevant medications, and renal function. Results Sixty percent of the study population (n=15,605) had metabolic syndrome. In the multivariate-adjusted analysis, presence of metabolic syndrome was associated with an increased risk for ESRD (hazard ratio=1.33, 95% confidence interval=1.08, 1.64) but not death (hazard ratio=1.04, 95% confidence interval=0.97, 1.12) during a mean follow-up of 2.3 years. Among the individual components of metabolic syndrome, impaired glucose metabolism, elevated triglycerides, and hypertension were associated with increased risk for ESRD, whereas low HDL cholesterol and impaired glucose metabolism were associated with higher risk of death. Conclusions Presence of metabolic syndrome is associated with ESRD but not death in patients with stages 3 and 4 CKD.