Changes in metabolic syndrome status affect the incidence of end-stage renal disease in the general population: a nationwide cohort study

Eun Sil Koh,Eun Sook Kim,Min-Kyung Lee,Hyuk-Sang Kwon,Kyung Do Han,Ga Eun Nam,Oak-Kee Hong,Mee Kyoung Kim

doi:10.1038/s41598-021-81396-0

Abstract

Few studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population. Using nationally representative data from the Korean National Health Insurance System, 13,310,924 subjects who underwent two health examinations over 2 years and were free from end-stage renal disease (ESRD) from 2009 to 2012 were followed to the end of 2016. The subjects were divided into four groups according to the change in MetS components between the two visits over 2 years: no MetS (–/–), post-MetS (–/+), pre-MetS (+/–), and both MetS (+/+). After a median follow up of 5.11 years, 18,582 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD in the both-MetS (+/+) group compared with the no-MetS (–/–) group was 5.65 (95% CI, 5.42–5.89), which was independent of age, sex, and baseline estimated glomerular filtration rate. Additionally, the HR for the pre-MetS (+/–) group versus the no-MetS (–/–) group was 2.28 (2.15–2.42). In subgroup analysis according to renal function, the impact of a change in MetS on the incidence of ESRD was more pronounced in individuals with advanced renal dysfunction. Subjects with resolved MetS components had a decreased risk of ESRD, but not as low as those that never had MetS components. This provides evidence supporting the strategy of modulating MetS in the general population to prevent the development of ESRD.

Highlights

Few studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population
Because impaired fasting glucose and elevated blood pressure (BP) are included in the definition of MetS, investigations of the independent associations among the other three components of MetS and renal outcome are important
We analysed the impact of the presence of each MetS component on the incidence of end-stage renal disease (ESRD) (Table 2)

Summary

Introduction

Few studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population. Metabolic syndrome (MetS) is defined as the simultaneous occurrence of at least three of the following: abdominal obesity, elevated blood pressure (BP), elevated plasma glucose, and d yslipidaemia[1] When these metabolic abnormalities are grouped together, they are associated with an increased risk of both diabetes and cardiovascular disease (CVD). Stefansson and collaborators[3] confirmed MetS as an independent risk factor for an accelerated age-related glomerular filtration rate (GFR) decline in the general population. They showed that individuals with baseline MetS had a significantly faster mean decline of 0.30 mL/min/year compared with individuals without MetS in a multivariable adjusted linear regression model.

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Conclusion