Metabolic syndrome loses its predictive power in late-stage chronic kidney disease progression--a paradoxical phenomenon.
BACKGROUND
Metabolic syndrome (MS) is a significant determinant of CKD. The aim of this study was to determine the possible impact of MS on CKD progression.


METHODS
746 CKD subjects were included. The presence of MS was determined according to the modified criteria proposed by the Adult Treatment Panel (ATP) III. The study endpoints were stage-to-stage CKD progression or starting renal replacement therapy during the study period. CKD Stages 1, 2 and 3 were defined as early-stage CKD, while CKD Stages 4 and 5 were defined as late-stage CKD.


RESULTS
Early-stage CKD patients with MS had a higher risk of CKD progression than those without MS. Cox regression analysis showed that MS was a significant determinant of CKD progression in early-stage (HR: 1.60, p=0.041) but not late-stage CKD patients (HR: 1.00, p=0.975). The results of subgroup analysis in non-diabetic subjects also showed that only early-stage CKD subjects with MS had significant risks of CKD progression (HR: 2.21, p=0.010). In diabetic patients, the association between MS and CKD progression was not significant in both early- and late-stage CKD.


CONCLUSIONS
Our findings suggested that the impact of MS on CKD progression might be prominent in non-diabetic early-stage CKD subjects, and became non-significant in diabetic late-stage CKD and diabetic CKD patients.
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
C-C
CC
Lee
C Y
CY
Sun
I-W
IW
Wu
S-Y
SY
Wang
M-S
MS
Wu
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors
D015415:Biomarkers