title: Metabolic syndrome is associated with impaired long-term renal allograft function; not all component criteria contribute equally.
abstract: Chronic renal transplant dysfunction (CRTD) remains a leading cause of renal allograft loss. Evidence suggests that immunological and ischemic insults are mainly associated with CRTD occurring within the first year after transplantation, whereas nonimmunological insults are predominantly associated with CRTD beyond the first year. Several cardiovascular risk factors, such as obesity, dyslipidemia, hypertension, and diabetes mellitus have been identified as important nonimmunological risk factors for CRTD. These risk factors constitute the metabolic syndrome (MS). As renal allograft function is a surrogate marker of renal allograft loss, we investigated the association of MS with impairment of renal allograft function beyond the first year after transplantation in a cross-sectional study of 606 renal transplant outpatients. Metabolic syndrome was defined using the definition of the National Cholesterol Education Program. Renal allograft function was assessed as the 24-h urinary creatinine clearance. A total of 383 out of 606 patients (63%) suffered from MS at a median time of 6 years (2.6-11.4) post-transplant. Presence of MS was associated with impaired renal allograft function beyond 1 year post-transplant [-4.1 mL/min, 95%CI (-7.1, -1.1)]. The impact of MS did not change appreciably after adjustment for established risk factors for CRTD [-3.1 mL/min, 95%CI (-6.0, -0.2)]. However, not all component criteria of MS contributed equally. Only systolic blood pressure and hypertriglyceridemia were independently associated with impaired renal allograft function beyond 1 year post-transplant in multivariate analyses.
authors.affiliation: Renal Transplant Program, Groningen University Medical Center, Groningen, The Netherlands. a.p.j.de.vries@int.azg.nl
authors.forename: Aiko P J
authors.initials: AP
authors.lastname: de Vries
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van Son
authors.forename: Jaap J Homan
authors.initials: JJ
authors.lastname: van der Heide
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.forename: Hauw T
authors.initials: HT
authors.lastname: The
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Reinold O B
authors.initials: RO
authors.lastname: Gans
mesh_terms: D000328:Adult; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D016030:Kidney Transplantation; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism*; D008875:Middle Aged; D013997:Time Factors; D019737:Transplants
chemical_list: D003404:Creatinine