title: Metabolic Syndrome and Smoking Are Associated with Future Development of Advanced Chronic Kidney Disease in Older Adults.
abstract: BACKGROUND
  Metabolic syndrome (MetS) and smoking have been identified as risk factors for chronic kidney disease (CKD) in cross-sectional studies in various age groups, but longitudinal data on progression of CKD in older adults are limited. Our objectives were to examine whether MetS and its components and smoking predict the onset of CKD stage 3b (CKD-3b) in older adults.
  
  
  METHODS
  A subset of participants of the Einstein Aging Study who were free of diabetes, dementia, and CKD-3b at enrollment were included in this analysis. CKD-3b was defined as an estimated glomerular filtration rate <45 ml/min/1.73 m(2). Cox proportional hazards models were used in these analyses.
  
  
  RESULTS
  In total, 413 ≥70-year-old individuals were eligible for this study. 65.4% were female and 26.6% were black. 22.3% of the participants had MetS at baseline, 4.4% were active smokers, and 6.1% developed CKD-3b over a mean of 4 years of follow-up. MetS and smoking independently predicted incident CKD in our fully adjusted model (hazard ratio 3.65, 95% CI 1.20-10.60, p = 0.022; hazard ratio 29.69, 95% CI 4.47-197.23, p = 0.000).
  
  
  CONCLUSIONS
  MetS and smoking are associated with an increased incidence of CKD-3b. These risk factors are modifiable, easily identified and prevented through better health care practice and early diagnosis.
authors.affiliation: Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Zammit
authors.affiliation: Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA.
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Katz
authors.affiliation: Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Derby
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Mich., USA.
authors.forename: Markus
authors.initials: M
authors.lastname: Bitzer
authors.affiliation: Departments of Neurology, Albert Einstein College of Medicine, Bronx, N.Y., USA; Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, N.Y., USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
keywords: Chronic kidney disease; Metabolic syndrome; Smoking