Metabolic syndrome in peritoneal dialysis patients: choice of diagnostic criteria and prognosis

Abstract

Objectives To investigate whether the presence of metabolic syndrome (MS) modifies overall survival and cardiovascular (CV) outcomes among patients undergoing long-term peritoneal dialysis (PD) and to explore suitable diagnostic criterion for PD patients. Methods A total of 258 patients on PD in Peking University Third Hospital between October 2008 and March 2009 were enrolled and followed until June 2017. According to the diagnostic criteria of WHO, IDF and ATP Ⅲ, the patients were divided into MS group and non-MS group. The median following time was 51.9(26.8, 97.9) months. Overall survival and cardiovascular death were analyzed by the Kaplan-Meier method. The analyses were also done among non-diabetic PD patients. The influence of MS and its components on outcomes was analyzed by Cox regression models. Results Among 258 PD patients, 106(41.1%) fulfilled the WHO criteria, 121(46.9%) the IDF criteria, and 167(64.7%) the ATP criteria.139 cases were dead, among which 50(36.0%) cases were caused by CV diseases. The patients with MS had worse outcomes than those without MS by WHO and IDF criteria (cumulative survival rates of WHO criteria: 21.3% vs 44.8%, P<0.01; cumulative surviva rats of IDF criteria: 23.3% vs 45.7%, P<0.01). It was the same even in non-diabetic PD patients. The patients with MS had more CV death than those without MS by WHO and IDF criteria (both P<0.05). Among non-diabetic PD patients, the results remained the same only by IDF criteria (P<0.05). By ATP criteria, above analyses showed no difference. By multivariate Cox regression analysis, MS and serum albumin (all P<0.01) were independently associated with increased risk for overall and cardiovascular survival. Among MS components, waist girth, low-density lipoprotein cholesterol (LDL-C) levels and blood sugar (all P<0.01) were significant risk factors for adverse survival outcomes. Conclusions In patients undergoing PD, both overall survival and cardiovascular survival were worse in patients with MS than those without MS. Waist girth, blood sugar and serum LDL-C were the main risk factors. For PD patients the IDF criterion for MS was recommended. Key words: Metabolic syndrome X; Peritoneal dialysis; Prognosis; Diagnostic criteria