title: Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly.
abstract: BACKGROUND
  Studies addressing the association of metabolic syndrome and insulin resistance with the risks of incident chronic kidney disease (CKD) and the progression of renal function were either lacking or inconclusive.
  
  
  OBJECTIVE
  The aim of this study was to define the effect of metabolic syndrome and insulin resistance on the development of new CKD and the decline in renal function.
  
  
  METHODS
  A prospective cohort study was conducted at a tertiary university-based hospital in Taiwan.
  
  
  METHODS
  We studied a total of 1456 Asians 65 or older who were followed for an average of 3.15 yr. Within the cohort, we measured insulin resistance using the homeostasis model assessment formula in 652 nondiabetic participants.
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  We measured the prevalence and incidence of CKD and the annual decline of the estimated glomerular filtration rate.
  
  
  RESULTS
  We found that the adjusted odds ratio for prevalent CKD in association with metabolic syndrome was 1.778 (95% confidence interval, 1.188 to 2.465), the hazard ratio for rapid decline in renal function was 1.042 (0.802-1.355), and the hazard ratio for incident CKD was 1.931 (1.175-3.174). With each one-unit increment of insulin resistance, the odds ratio of prevalent CKD and proteinuria were raised 1.312-fold (1.114 to 1.545) and 1.278-fold (1.098 to 1.488), respectively. Insulin resistance was not associated with incident CKD. Increment of insulin resistance per unit was associated with 1.16-fold (1.06 to 1.26) elevation in the hazard ratios of the decline in renal function.
  
  
  CONCLUSIONS
  Metabolic syndrome predicts the risks of prevalent and incident CKD, whereas insulin resistance is associated with prevalent CKD and rapid decline in renal function in elderly individuals.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung Shan South Road, Taipei 100, Taiwan. ycjycj@ntuh.gov.tw
authors.forename: Hui-Teng
authors.initials: HT
authors.lastname: Cheng
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Yen
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000208:ethnology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000208:ethnology / Q000378:metabolism* / Q000503:physiopathology* / Q000652:urine; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology