title: Metabolic syndrome, but not insulin resistance, is associated with an increased risk of renal function decline.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of metabolic syndrome (Mets) and insulin resistance (IR) on the risk of renal function decline (RFD) in a rural Chinese cohort.
  
  
  METHODS
  A total of 2696 subjects aged 40-71 years with normal renal function were followed-up for 7 years. RFD was defined using the Kidney Disease: Improving Global Outcome definition, i.e., a drop in estimated glomerular filtration rate (eGFR) category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 mL/min/1.73 m(2)/year.
  
  
  RESULTS
  During the 7-year follow-up, 9.0% of the subjects developed RFD. Subjects with Mets at baseline had an increased risk of RFD with an adjusted odds ratio (OR) of 1.77 (95%CI: 1.25-2.52), and there was a graded relationship between the numbers of Mets components and the risk for RFD. Exclusion of the subjects with hypertension (1.65; 0.99-2.75) or diabetes (1.86; 1.30-2.67) at baseline or further adjustment for IR (1.72; 1.15-2.57) did not substantially change the association between Mets and the risk of RFD. Moreover, the ORs of Mets status for RFD in the older group (≥55 years) were 2.14 (1.06-4.33) times of that in the younger group (<55 years) and 2.26 (1.07-4.78) times in hypercholesterolemia group (≥5.2 mmol/L) of that in the normal (<5.2 mmol/L) group. The baseline IR was not associated with the risk for RFD.
  
  
  CONCLUSIONS
  Mets, but not IR, was associated with an increased risk for RFD. And there was a detrimental interaction of Mets with older age and hypercholesterolemia on the risk of RFD.
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Youbao
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China.
authors.forename: Di
authors.initials: D
authors.lastname: Xie
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China.
authors.forename: Xianhui
authors.initials: X
authors.lastname: Qin
authors.affiliation: Institute of Biomedicine, Anhui Medical University, Hefei, China.
authors.forename: Genfu
authors.initials: G
authors.lastname: Tang
authors.affiliation: Institute of Biomedicine, Anhui Medical University, Hefei, China.
authors.forename: Houxun
authors.initials: H
authors.lastname: Xing
authors.affiliation: Institute of Biomedicine, Anhui Medical University, Hefei, China.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Li
authors.affiliation: Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China.
authors.forename: Xiping
authors.initials: X
authors.lastname: Xu
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China. Electronic address: xinxxu@gmail.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Institute of Nephrology, Southern Medical University, Guangzhou, China. Electronic address: ffhouguangzhou@163.com.
authors.forename: Fanfan
authors.initials: F
authors.lastname: Hou
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors
keywords: Hypercholesterolemia; Insulin resistance; Metabolic syndrome; Renal function decline; Rural Chinese population