Metabolic Syndrome Predicts New Onset Of Chronic Kidney Disease In 5829 Patients with Type 2 Diabetes – A 5-year Prospective Analysis of the Hong Kong Diabetes Registry

Abstract

Objective: Type 2 diabetes is the leading cause of end stage renal disease worldwide. Aside from hyperglycemia and hypertension, other metabolic factors may determine renal outcome. We examined risk associations of metabolic syndrome (MetS) with new onset of chronic kidney disease (CKD) in 5829 Chinese patients with type 2 diabetes enrolled between 1995 and 2005.

Method: MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III with Asian definition of obesity. Estimated glomerular filtration rate (eGFR) was calculated using abbreviated Modification of Diet in Renal Disease formula modified for Chinese population. New onset of CKD was defined as estimated eGFR < 60 ml/min/1.73m² at the time of censor. Subjects with CKD at baseline were excluded from the analysis.

Results: After a median follow-up duration of 4.6 years [inter-quartile range: 1.9 – 7.3 years], 741 patients developed CKD. The multivariable-adjusted hazard ratio of CKD was 1.31, 95% confidence interval [CI] 1.12 – 1.54, p=0.001 for subjects with MetS compared to without. Relative to subjects with no other components of MetS except for diabetes, those with two, three, four and five MetS components had increased risk of CKD (hazard ratio [95% CI, p value]) of 1.15 [0.83 – 1.60, p=0.407], 1.32 [0.94 – 1.86, p=0.112], 1.64 [1.17 – 2.32, p=0.004] and 2.34 [1.54 – 3.54, p<0.001], respectively. The MetS traits of central obesity, hypertriglyceridemia and hypertension as well as low BMI were independent predictors for CKD.

Conclusion: The presence of MetS independently predicts the development of CKD in subjects with type 2 diabetes.