Original Investigation
Pathogenesis and Treatment of Kidney Disease
Time-Dependent Association Between Metabolic Syndrome and Risk of CKD in Korean Men Without Hypertension or Diabetes

https://doi.org/10.1053/j.ajkd.2008.07.027Get rights and content

Background

The time-dependent association between metabolic syndrome and risk of chronic kidney disease (CKD) is not clear.

Setting & Participants

The study cohort was composed of 10,685 healthy men without CKD, hypertension, or diabetes who participated in a health-checkup program at a large work site.

Predictor

Metabolic syndrome.

Outcomes & Measurements

CKD was defined as an estimated glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2. A standard Cox proportional hazards model and a time-dependent Cox model were used to calculate adjusted hazard ratios (HRs) in the CKD model.

Results

During 40,616.8 person-years of follow-up, 291 incident cases of CKD developed; 787 patients (7.4%) had metabolic syndrome at baseline and 1,444 (14.4%) developed incident metabolic syndrome during follow-up. After adjustment for age, baseline GFR, γ-glutamyltransferase level, and uric acid level, metabolic syndrome at baseline was associated with a significantly increased risk of CKD (HR, 1.99; 95% confidence interval, 1.46 to 2.73). Metabolic syndrome over time as a time-dependent variable also predicted the development of CKD (HR, 1.75; 95% confidence interval, 1.28 to 2.39). The relationship between metabolic syndrome and incident CKD remained significant, even after further adjustment for the homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein level, current smoking, alcohol consumption, or regular exercise. In addition, there were graded relationships between number of metabolic syndrome traits or quintile of homeostasis model assessment of insulin resistance over time as a time-dependent variable and risk of CKD. Both increased triglyceride and low high-density lipoprotein cholesterol levels among metabolic syndrome traits were associated with significantly increased risk of CKD. These results were effectively unchanged, even after additional adjustment for incident hypertension and incident diabetes.

Limitations

Estimated GFR was used instead of a directly measured GFR to define CKD.

Conclusion

Metabolic syndrome is an independent risk factor for the development of CKD in Korean men without hypertension or diabetes, even with changes in status of metabolic syndrome over time.

Section snippets

Study Population

The study population was composed of Korean working men and was described in detail previously.19, 20 The study population included workers 40 years or older who underwent an annual comprehensive health examination and workers 30 to 39 years who underwent a biennial comprehensive health examination. In 2002, a total of 15,347 workers aged 30 to 59 years participated in the comprehensive health examination at a university hospital in Seoul, Korea. A total of 3,320 men were excluded from the

Results

At baseline, mean age of the 10,685 participants in the analytic cohort was 37.0 ± 4.8 years (range, 30 to 59 years). During follow-up, 7 men died of nonrenal diseases. Six of these men were not included in the analytic cohort. Men who did not participate in follow-up examinations (n = 1,342) were on average 0.8 years older and more likely to be current smokers and current consumers of alcohol than those included in the analytic cohort. None of the other variables differed between participants

Discussion

In the present prospective study of nonhypertensive and nondiabetic Korean men, metabolic syndrome at baseline was associated with the development of CKD, and this relationship was observed even after updating the status of metabolic syndrome on follow-up. In addition, there were graded relationships between number of metabolic syndrome traits or quintiles of HOMA-IR over time as a time-dependent variable and risk of CKD. Increased triglyceride and low HDL-C levels among metabolic syndrome

Acknowledgements

Support: This work was supported by the Korea Research Foundation Grant funded by the Korean Government (MOEHRD; KRF-2006-331-E00090).

Financial Disclosure: None.

References (49)

  • P. Muntner et al.

    Plasma lipids and risk of developing renal dysfunction: The Atherosclerosis Risk in Communities Study

    Kidney Int

    (2000)
  • R.P. Gelber et al.

    Association between body mass index and CKD in apparently healthy men

    Am J Kidney Dis

    (2005)
  • K. Iseki et al.

    Body mass index and the risk of development of end-stage renal disease in a screened cohort

    Kidney Int

    (2004)
  • J. Coresh et al.

    Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate

    Am J Kidney Dis

    (2002)
  • Prevalence of chronic kidney disease and associated risk factors—United States, 1999-2004

    MMWR Morb Mortal Wkly Rep

    (2007)
  • K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification

    Am J Kidney Dis

    (2002)
  • B. Balkau et al.

    Comment on the provisional report from the WHO consultation: European Group for the Study of Insulin Resistance (EGIR)

    Diabet Med

    (1999)
  • Executive summary of the Third Report of the National Cholesterol Education Program (NECP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • C. Lorenzo et al.

    Central adiposity determines prevalence differences of the metabolic syndrome

    Obes Res

    (2003)
  • E.S. Ford et al.

    Increasing prevalence of the metabolic syndrome among U.S. adults

    Diabetes Care

    (2004)
  • S. Lim et al.

    Korean National Health and Nutrition Examination Surveys: Changes in the characteristics of metabolic syndrome in Korea over the period 1998-2001 as determined by Korean National Health and Nutrition Examination Surveys

    Diabetes Care

    (2005)
  • D.E. Laaksonen et al.

    Metabolic syndrome and development of diabetes mellitus: Application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study

    Am J Epidemiol

    (2002)
  • M. Trevisan et al.

    Syndrome X and mortality: A population-based studyRisk Factor and Life Expectancy Research Group

    Am J Epidemiol

    (1998)
  • H.M. Lakka et al.

    The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

    JAMA

    (2002)
  • Cited by (74)

    View all citing articles on Scopus

    Originally published online as doi:10.1053/j.ajkd.2008.07.027 on October 6, 2008.

    View full text