title: Effect of metabolic syndrome on clinical outcomes of non-diabetic peritoneal dialysis patients in India.
abstract: OBJECTIVE
  Metabolic syndrome (MS) is associated with higher mortality and morbidity in the general population. However, the effect of MS and its individual components on clinical outcomes in non-diabetic peritoneal dialysis (PD) patients has not been widely studied in India. Our aim was to study the prevalence of MS in non-diabetic PD patients who were on PD for at least 3 months and to analyze the influence of MS and its individual components on clinical outcomes of these patients on subsequent follow up.
  
  
  METHODS
  We prospectively included 163 non-diabetic PD patients (mean age 45.1 ± 16.2 years, 104 male). MS was defined using the modified National Cholesterol Education Programme (ATP III) criteria. Outcomes of patients with and without MS were compared.
  
  
  RESULTS
  Of the 163 non-diabetic PD patients, 84 (51.5%) patients had MS. The mean follow up duration was 24.0 ± 14.0 patient months. Patients with MS had significantly greater body mass index (P = 0.007), Systolic BP (P = 0.001), diastolic BP (P = 0.001), Triglycerides (P = 0.002), total cholesterol (P = 0.001) level; and significantly lower high density lipoprotein (P = 0.013) values. Mean survival (patient-months) of patients with MS (30.7 (95%CI 27.1-34.3)) was significantly inferior to that of patients without MS (55.6 (95% CI 50.8-60.4), P = 0.001). Mean technique survival of patients with MS was also significantly lower (38.9 (95% CI 35.9-41.9)) compared to that of patients without MS (61.5 (95% CI 58.3-64.7), P = 0.039). On univariate Cox regression analysis diastolic BP (P = 0.003), Systolic BP (P = 0.026), hypertension (HTN) (P = 0.001) and MS (P = 0.001) were found to be independent predictors of mortality. However on multivariate Cox hazard regression analysis, only MS (HR 5.39 (95% CI 2.06-14.14), P = 0.001) was found to be the significant predictors of mortality in these patients. Among the factors other than components of MS, the presence of comorbidities (P = 0.029), serum albumin (P = 0.042), non-HDL cholesterol (P = 0.003), total cholesterol/HDL (P = 0.001) and MS (P = 0.001) were important factors predicting mortality on univariate Cox regression, while only MS (P = 0.001) and serum albumin (P = 0.013) were the independent factors predicting mortality on multivariate analysis.
  
  
  CONCLUSIONS
  Prevalence of MS in non-diabetic PD patient is high and predicts long term patient and technique survival.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.forename: Archana
authors.initials: A
authors.lastname: Sinha
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Raj K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Anupama
authors.initials: A
authors.lastname: Kaul
authors.forename: Dharmender
authors.initials: D
authors.lastname: Bhadauria
authors.forename: Dharshan
authors.initials: D
authors.lastname: Ranagswamy
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008055:Lipids
keywords: metabolic syndrome; non-diabetic patient; peritoneal dialysis