Association Between Metabolic Syndrome And Chronic Kidney Disease In A Community Population

BACKGROUNDChronic kidney disease (CKD), hypertension, diabetes and cardiovascular disease (KHDC) were the most important chronic noninfectious diseases not only in the developed countries but also in developing countries. Many of the patients developed into end stage renal disease (ESRD) which needs dialysis or kidney transplantation, and become the unbearable medical burden of the governments and individuals. In the west countries, hypertension and diabetes have become the main causes of ESRD. Despite recent advances in the treatment of chronic kidney disease (CKD), it remains an important public health challenge. CKD is a major risk factor for end stage renal disease (ESRD) and cardiovascular disease, and cardiovascular disease is the leading cause of mortality in uremic patients. Cardiacmortality in dialysis patients ismore than10-fold greater than that of the general population. Metabolic syndrome refers to a cluster of metabolic abnormalities (abdominal obesity, hyperglycemia, dyslipidemia, and hypertension) related to a state of insulin resistance, often associated with an overweight or obese state. This clinical entity has been known to increase the risk of cardiovascular disease (CVD), type2diabetes, chronic kidney disease (CKD), and total mortality. Metabolic syndrome is highly prevalent worldwide, with a prevalence ranging from10to40%in different populations. Recently emerging data have suggested that metabolic syndrome is an important risk factor for CKD. To better understand the relationship between MS and CKD and hunt for early biomarkers of diabetic nephropathy from urine exsome, and to further promote the theoretical basis for early diagnosis of diabetic nephropathy industrialization in the world, European Union Science and Teckonlogy Minstry and Southern Medical University proposed SEVENTH FRAMEWORK PROGRAMME THE PEOPLE PROGRAMME- Biomarker Applications for Nanotechnology and Imaging in Diabetes. The presented studies were epidemical investation parts of the program in ZhuHai. Our studies were supported by SEVENTH FRAMEWORK PROGRAMME THE PEOPLE PROGRAMME and the fund of Guangdong province, China. The aim was to obtain the epidemic data of CKD, MS and it related componoents, such as abdominal obesity, hyperglycemia, dyslipidemia, hypertension and serun urie acid in the community residents, and to explore the relationship of CKD and MS and it’s componoents, to further provide scientific evidence to strengthen the prevention and treatment of CKD and related diseases.OBJECTIVE1. To explore the relationship between metabolic syndrome (MS) and risk for chronic kidney disease (CKD) in a Southern Chinese population.2. To explore the association between metabolic syndrome (MetS) and chronic kidney disease (CKD) in perimenopausal women.3. To examine the relationship between the HW phenotype and risk for CKD in a community population aged40years and older.4. To explore the relationships between visceral adiposity index(VAI), hypertriglyceridemic waist phenotype (HW phenotype) and chronic kidney disease(CKD).5. To explore the association between NAFLD and CKD in community population with prediabetes or diabetes.6. A database was founded and prepared for further prospective follow-up.METHODSMetabolic Syndrome and Chronic Kidney Disease in a Southern chinese populationThis cross-sectional study was conducted in Wanzhai Town, Zhuhai City, a prominent commercial city in Southern China. Data was collected from2142community residents,18-75years of age in from June to October,2012. Participants were selected using a multi-stage stratified random cluster sampling method, step1, two communities were selected randomly from Wanzhai Town; step2, in each of the2selected communities,500families were randomly sampled as the target family; and step3, all the residents aged from18-75in the selected families were sampled. Using this method, a total of2142participants from2603residents complete the survey, with a response rate of82.2%. Participants were recruited by mail and home visits. First, we informed participants by mail. Then we visited the families and got the questionnaires. All community residents gave their written informed consent. This study was approved by The Ethics Committee of The Third Affiliated Hospital of Southern Medical University, Guangzhou. This study was performed fulfilling the principles of Helsinki Declaration and the International Guidelines for Ethical Review for Epidemiological Studies. Study VariablesSociodemographic characteristics, including personal health history (coronary artery disease, stroke, hypertension, and diabetes) and details about lifestyle (smoking status, alcohol intake, diet habits and physical activity) were obtained by questionnaire. Body weight, height, waist circumference and blood pressure were measured with standardized protocol in the morning between08:00and11:00am. Blood pressure was measured twice to the nearest2mmHg by a trained nurse using a mercury totally closed desk-top sphygmomanometer (Model XJ300/40-1, Shanghai, China), after the participants had been seated at least5minutes. The first and forth Korotkoff sounds were used to represent the systolic and diastolic blood pressure, respectively. The average value of these two measuring points for systolic and diastolic blood pressure was recorded.Blood glucose level was measured with a hexokinase enzyme reference method and serum creatinine (SCr) with an enzymatic method on an autoanalyzer (Hitachi7170, Hitachi, Tokyo, Japan). Serum high-density lipoprotein (HDL) was determined enzymatically with commercially available reagents (Shanghai Gensource Co., Ltd, Shanghai, China), and cholesterol and triglyceride (TG) levels were determined enzymatically with commercially available reagents (Roche Diagnostics, Mannheim, Germany). High sensitivity C-reactive protein was measured by enzymatic Turbidimetric immunoassay method (Orion Diagnostica Oy, Espoo, FinLand). Urinary albumin and creatinine were measured from a fresh morning spot urine sample or first morning urine sample stored at+4℃for less than1week. Albuminuria was measured with immunoturbidimetric tests (Audit Diagnostics, Cork, Ireland). Urinary creatinine was measured with Jaffe’s kinetic method. The urinary albumin to creatinine ratio (ACR; mg/g creatinine) was calculated.Association between Metabolic Syndrome and Chronic Kidney Disease in Perimenopausal WomenThis cross-sectional study was conducted in Wanzhai Town, Zhuhai City, a prominent commercial city in Southern China. Data was collected from763community perimenopausal women residents,40-65years of age from June to October,2012. Of these,685community perimenopausal women met the inclusion criteria. Study VariablesThe same as "Metabolic Syndrome and Chronic Kidney Disease in a Southern chinese population"Hypertriglyceridemic Waist Phenotype and Chronic Kidney Disease in a Chinese Population Aged40years and OlderThe Ethics Committee of The Third Affiliated Hospital of Southern Medical University, Guangzhou, approved this study. This study was performed fulfilling the principles of Helsinki Declaration and the International Guidelines for Ethical Review for Epidemiological Studies. Data was collected from1753community residents older than40years from June to October,2012. Participants were selected using a multi-stage stratified random cluster sampling method. Step1, two communities were selected randomly from Wanzhai Town; step2, in each of the two selected communities,500families were randomly sampled as the target family; and step3, all the residents aged40years and older in the selected families were sampled. The exclusion criteria included:missing gender; age; education status; missing any item of lifestyle information (for example, smoking status, alcohol intake, and physical activity); not being in the fasting state for at least10hours; missing any item of waist measurement, blood pressure (BP), body mass index (BMI), blood glucose, serum high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels information. Using this method, a total of1753participants from2198residents completed the survey, with a response rate of79.8%.173participants were assigned to Group1.541participants were assigned to Group2and820participants belonged to Group3according to their waist circumferences and triglyceride levels. Participants were recruited by mail and home visits. First, we informed participants by mail. Then we visited the families and got the filled questionnaires from the participants. All participants signed a letter of informed consent. Study VariablesThe same as "Metabolic Syndrome and Chronic Kidney Disease in a Southern chinese population"Visceral Adiposity Index, Hypertriglyceridemic Waist Phenotype and Risk of Chronic Kidney DiseaseThe same as "Metabolic Syndrome and Chronic Kidney Disease in a Southern chinese population"Association between Non-alcoholic Fatty Liver Disease and Chronic Kidney Disease in Population with Prediabetes or Diabetes.This cross-cectional study was described in our previous article.334of2140subjects with history diagnosis diabetes or those with fasting plasma glucose are equal or greater than5.6mmol/L. The ethics committee of the Third Affiliated Hospital of Southern Medical University approved the study protocol. All participants gave their informed consent. This study was performed fulfilling the principles of Helsinki Declaration and the International Guidelines for Ethical Review for Epidemiological Studies. Study VariablesNAFLD was diagnosed by abdominal ultrasonography scanning which was performed onparticipants by an experienced radiologist, who was blind to participants’details. Other variables are same as "Metabolic. Syndrome and Chronic Kidney Disease in a Southern chinese population"Diagnostic criteriaDetermination of MSAccording to the definition of the International Diabetes Federation (IDF), MS can be diagnosed when central obesity (waist measurement≥90cm for men or≥80cm for women) is accompanied by any2of the following4factors:(1) a TG level of1.7mmol/l or greater;(2) an HDL cholesterol level lower than1.03mmol/1for men or lower than1.29mmol/1for women;(3) a blood pressure (BP) of130/85mmHg or higher or receiving treatment for previously diagnosed hypertension;(4) a fasting blood glucose (FBG) of5.6mmol/1or higher or with previously diagnosed type2diabetes.According to the criteria of the NCEP ATP Ⅲ. Thus, MS was defined as the presence of three or more of the following five criteria:1) waist circumference≥90cm in males and≥80cm in females,2) triglycerides≥150mg/dL or under treatment for elevated triglycerides,3) high-density lipoprotein (HDL)-cholesterol<40mg/dL in males and<50mg/dL in females or under treatment for reduced HDL,4) SBP≥130mmHg or DBP≥85mmHg or under treatment for hypertension and5) fasting glucose≥100mg/dL or under treatment for elevated glucose.Determination of CKDThe estimated glomerular filtration rate (eGFR), an indicator of kidney function, was estimated using a formula from the Chinese-Modification of Diet Renal Disease (C-MDRD) study:GFR (ml/min/1.73m2)=175×(Scr)-1.234×(Age)-0.179×(if female,×0.79).[16]Reduced renal function was defined as an eGFR of less than60mL/min per1.73m2.For practical purposes, albuminuria was defined as a spot urinary albumin-to-creatinine ratio higher than30mg/g. CKD was defined as an eGFR of less than60ml/min per1.73m2or albuminuria.Determination of Hypertension and Diabetessystolic BP≥140mmHg or diastolic BP≥90mmHg or under treatment for hypertension diagnosed hypertension. Fasting glucose≥7.0mmol/l or under treatment for treatment for previously diagnosed diabetes diagnosed diabetes.Definition of HW phenotypeThe HW phenotype was defined as elevated waist circumference (>90cm in men and>85cm in women), along with an elevated plasma triglyceride concentration (>2.0mmol/L(177mg/dl).Definition of VAI scoreThe VAI score was calculated according to a published formula:Males:VAI=[WC/39.68+(1.88×BMI)]×(TG/1.03)×(1.31/HDL)Females:VAI=[WC/36.58+(1.89×BMI)]×(TG/0.81)×(1.52/HDL)Diagnosis criterion of NAFLDNAFLD was diagnosed by abdominal ultrasonography scanning which was performed on participants by an experienced radiologist, who was blind to participants’details. And including those main criteria:echo contrast between liver relative and the kidney, unclear display of intrahepatic lacuna structure, liver brightness, deep attenuation, and vascular blurring. And excluding those:(1) with ethanol intake per week is more than140g in men and70g in women;(2) with specific diseases that could result in fatty liver, such as viral hepatitis, drug-induced liver disease;(3) positive for hepatitis B or C viruses other types of liver diseases, including primary biliary cirrhosis, autoimmune hepatitis.STATISTIC ANALYSISData were analyzed using Stata (version11). Continuous variables were shown as mean±standard deviation if they had normal distribution. Median and interquartile range were used to show skewed distributed continuous variables. The categorical variables were presented as absolute and relative (%) values or proportion. A two-tailed p value<0.05was considered significant. Baseline characteristics were examined using the chi-squared test for categorical variables and Student’s t test or Wilcoxon rank-sum test for continuous variables. Logistic regression test was used in risk factor analysis. P value of<0.05was considered statistically significant. RESULTSMetabolic Syndrome and Chronic Kidney Disease in a Southern chinese populationInitially2142participants completed the survey in our community study, and418participants were excluded because of the missing data of serum creatitine, serum HDL, serum LDL, serum fast glucose, anthropometric indexes, or ACR. Finally,1724participatns were included in the study. Among the total participants,383(22.22%) had MS. In general, all participants were of Han ethnicity and37.29%were men.Baseline Characteristics of non-MS and MS subgroups22.22%of the overall population had MS. Generally, participants with MS were older and had lower education level than those without MS (P<0.001). Subjects with MS had higher BMI, waist circumference, SBP, DBP, fasting glucose, SCr, serum uric acid, cholesterol, ACR, serum triglycerides, CRP, lower HDL, and lower eGFR than subjects without MS (P<0.001). Subjects with MS also had higher prevalence of CKD (P<0.001).Associations of MS with CKDMS was associated with CKD (P<0.001) in the unadjusted analyses. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between MS and CKD had impact on the odd ratios, but MS was still significantly associated with CKD. The odd ratio for MS was2.52(95%CI1.84,3.54, P<0.001). When adjusted for diabetes and hypertension, the association of MS and CKD was still significant (OR1.63,95%CI1.15,2.32, P=0.006)Prevalence of CKD by number of the MS componentsThe numbers of participants with0,1,2,3,4/5components were433,308,277,322and384, respectively. The prevelence of CKD in the subpopulation with0,1,2,3,4/5components of the MS were5.23%,11.37%,22.62%,31.90%and21.25%, respectively.Associations of number of MS components with CKDAfter adjusting for age, gender, current smoking, current alcohol use, education status and physical inactivity, three components and four/five components was associated with CKD. The OR for three components and four/five components were2.90(95%CI1.70,4.96, P<0.001) and3.64(95%CI1.95,6.80, P<0.001), when compared with those without component. Further adjustment for diabetes and hypertension, however, showed that the associations were not statistically significant.Associations of individual component of MS with CKDAfter adjusting for age, gender, current smoking, current alcohol use, education status and physical inactivity, higher blood pressure, higher serum triglyceride level, higher fast glucose and central obesity were seen to be associated with CKD (P<0.05). The odd ratios for elevated blood pressure, elevated serum triglyceride levels, elevated fasting glucose and central obesity were1.80(95%CI1.25to2.62, P=0.002),1.56(95%CI1.14to2.14, P=0.006),2.54(95%CI1.82to3.57, P<0.001), and1.50(95%CI1.10to2.07, P=0.01), respectively.Association between Metabolic Syndrome and Chronic Kidney Disease in Perimenopausal WomenAll participants were divided into3subgroups:Group1,40years old≤Age<50years old; Group2,50years old≤Age<60years old; Group3,60years old≤Age≤65years old. Initially there were763participants in our community study, but78participants were excluded because of missing data for serum creatinine, serum HDL, serum LDL, serum fast glucose, anthropometric indexes, or ACR. Finally,685participants were included in the study. Among the total participants,277participants belonged to Group1,256participants belonged to Group2, and152participants belonged to Group3.Baseline Characteristics of Each SubgroupsThe prevalence of history of coronary heart disease, history of hypertension, history of diabetes mellitus, abdominal obesity, elevated fasting glucose level, elevated blood pressure, CKD (p<0.001) and elevated triglyceride level (p=0.001) was significantly higher in Group3than in Group2; urinary albumin-to-creatinine ratio, fasting glucose, serum triglyceride, and serum low density lipoprotein (p<0.001), HOMA-index and serum uric acid (p=0.002) were significantly higher in Group3than in Group2. with the years old increasing, HOMA-index and serum uric acid were significantly higher (p=0.002); with the years old increasing, eGFR was significantly lower in Group3than in Group2(p<0.001).Associations of MS with CKD in Multivariate Logistic ModelMS was significantly associated with CKD with unadjusted Odds Ratio:3.04(1.79-5.14), p<0.001. After adjusting for age, history of stroke, history of coronary heart disease, smoking status, alcohol use, physical inactivity and education level, there was still strong association between MS and CKD.(muti-adjusted Odds ratio:2.66(1.54-4.59),p<0.001). Although the adjusted relationship between MS and CKD was not significant in Group1and Group3, the relationship holds for Group2(muti-adjusted Odds ratio:6.79(2.30-20.09),P<0.001).Associations of MetS Components with CKD in Group1There was no association between MetS components and CKD in Group1(p>0.05).Associations of MetS Components with CKD in Group2Elevated blood pressure (unadjusted Odds ratio:4.52(1.28-16.02), p=0.02) or Elevated fasting glucose (unadjusted Odds ratio:3.69(1.10-12.38),p=0.03) was associated with CKD. However, after adjusting for age, history of stroke, history of coronary heart disease, smoking status, alcohol use, physical inactivity and education level, the relationship disappeared (p>0.05).Hypertriglyceridemic Waist Phenotype and Chronic Kidney Disease in a Chinese Population Aged40years and OlderWe divided the participants into three groups according to their waist circumferences and triglyceride levels:Group1, waist circumference>90cm in men or>85cm in women and triglycerides≥2mmol/1; Group2, waist circumference <90cm in men or<85cm in women along with a plasma triglyceride concentration of=2.0mmol/L/waist circumference≥90cm in men or≥85cm in women along with a plasma triglyceride concentration of<2.0mmol/L; Group3, waist circumference≤90cm in men or≤85cm in women and triglycerides<2mmol/1.Initially there were1753participants aged40years and older in our study and all participants were Han ethnic.219subjects were excluded because of missing data for serum creatinine, ACR, triglyceride or waist circumference. Finally, we included1534participants with mean age57.21±10.97years in the current study.173participants were assigned to Group1.541participants were assigned to Group2and820participants belonged to Group3according to their waist circumferences and triglyceride levels.Baseline characteristics of the participants based on HW phenotypePatients in Group1had significantly higher serum uric acid, serum C-reactive protein, HOMA-index, BMI than those in Group2and Group3(P<0.001). Additionally, these values in Group2were significantly higher than those participants in Group3(P<0.001). Participants in Group1were older and had a higher prevalence of hypertension, diabetes, a higher diastolic blood pressure, higher levels of fasting glucose, ACR, and lower serum high-density lipoprotein than those in Group2and Group3(P<0.001). Current smoker status and current alcohol use statuses are more common in Group1than those in groups2and3. There were no differences in educational status (high school or above) and history of coronary heart disease among the participants in the three groups.Prevalence of CKD in the three subgroupsThere were46/173subjects (26.6%) with CKD in group1. Participants in group2had a higher prevalence of CKD90/541(16.6%) than those in group3,77/820(9.4%)(p<0.001). Participants in group1had the highest prevalence of CKD among the three subgroups.(p<0.001).Association of the HW phenotype with CKDGroup1was associated with CKD (OR3.08,95%CI2.01,4.73, P<0.001) in model one, when compared with Group3. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between the HW phenotype and CKD had an impact on the odd ratios, Group1was still significantly associated with CKD. The odd ratio for CKD was2.65(95%CI1.65,4.26, P<0.001). When adjusted for diabetes and hypertension, the association of Group1and CKD was still significant (OR2.09,95%CI1.26,3.45, P=0.004). Group2was associated with CKD (OR1.81,95%CI1.29,2.53, P=0.001) in model one, when compared with Group3. Further adjustment for history of hypertension, history of coronary heart disease, history of stroke, history of malignancy, current smoker, current alcohol use, physical inactivity, educational status, Group2was still significantly associated with CKD. The odd ratio for CKD was1.75(95%CI1.22,2.51, P=0.002). When adjusted for diabetes and hypertension, the association between Group2and CKD still existed. The odd ratio for CKD was1.48(95%CI1.01,2.16, P=0.046).Visceral Adiposity Index, Hypertriglyceridemic Waist Phenotype and Risk of Chronic Kidney DiseaseBoth men and women were categorized into four groups according to the gender-specific quartiles of VAI scores. We also divided the participants into three groups according to the recommended criteria for HW phenotype in Chinese population: Group1, normal WC (waist circumference<90cm in men or<80cm in women) and normal TG level (TG<1.7mmol/L) for both genders; Group2, solely WC increase (waist circumference≥90cm in men or≥80cm in women, along with triglycerides <1.7mmol/l) or solely TG increase (waist circumference<90cm in men or<80cm in women along with triglycerides≥1.7mmol/l); Group3, increased WC and TG level (waist circumference≥90cm in men or≥80cm in women and triglycerides≥1.7mmol/l).There were2142study subjects initially in our community study.314subjects were excluded because of missing data for waist circumference, triglycerides, BMI, HDL, ACR and serum creatitine.683men with a mean age of53.14±15.03and1145women with a mean age of52.3±14.19were included in our analysis.Baseline characteristics of the participants stratified by VAI quartilesParticipants were devided into four groups according to sex-specific VAI quartiles. The VAI medians (IQR) were1.37(0.82-2.21) for men and1.36(0.89-2.24) for women. There were dose-response relationships of serum uric acid, HOMA-IR, WC, BMI, diastolic blood pressure, serum C-reactive protein, serum triglyceride and total cholesterol with VAI scores in both men and women (P<0.001). While HDL were negative associate with VAI scores (P<0.001). For women, age, percentages of hypertension history, diabetes history progressively increased with increasing VAI scores(P<0.05), while this relationships were not seen in male subgroups(P>0.05).Baseline characteristics of the participants based on HW phenotypeFor both genders, participants in group3had significantly higher serum uric acid, WC, HOMA-IR, systolic blood pressure, diastolic blood, fasting glucose, serum C-reactive protein, total cholesterol, VAI scores than those in group1and group2(P <0.001). Subjects with the HW phenotype also had significantly a higher percentage of hypertension history and a lower levels of HDL than those without this phenotype(P<0.001). In additon, participants with the HW phenotype were older and more likely to have a history of diabetes than those without this phenotype in female subpopulation(P<0.05).Prevalence of CKDThe prevalence of CKD in quartile1, quartile2, quartile3and quartile4were13.6%,11.7%,17.3%and19.4%, respectively, in male subpopulation. These values were7.2%,8.2%,10.4%,19.9%, respectively, in female subpopulation. For men, there was no significant difference in the prevalence of CKD between subjects in quartile1and in quartile4(P=NS). While for women, subjects in quartile4had significantly a higher incidence of CKD than those in quartile1(P<0.001). The prevalence of CKD in group1, group2and group3were11.8%,16.2%and22%in male subpopulation, respectively. The corresponding values were7.0%,11.4%and22%in female subpopulation. Subjects in group3had significantly a higher prevalence of CKD than those in group1in both gender(P<0.05).Associations of VAI with CKDThe ORs for CKD increased with increasing quartiles of VAI scores, but a statistically significant trend was observed only in subjects with the highest quartile of VAI scores comparing to those with the lowest quartile. After adjustment for age, VAI were significantly associated with CKD (OR2.16,95%CI1.23to3.74, P=0.006, comparing the highest to the lowest quartile) in female subgroup. But this association was not seen in male(OR1.72,95%CI0.95to3.13, P=0.08, comparing the highest to the lowest quartile). For women, after further adjusted for history of hypertension, history of coronary heart disease, history of stroke, history of malignancy, current smoker, current alcohol use, physical inactivity, educational status, the association of VAI scores with CKD was also significant, experiencing a91%higher risk (OR1.91,95%CI1.06to3.40, P=0.03, comparing the highest to the lowest quartile). However, the association was abolished when adding diabetes and hypertension to the model(OR1.68,95%CI0.91to3.10, P=0.096).Associations of HW phenotype with CKDThe age-adjusted OR (95%CI, P) of CKD associated with HW phenotype was2.21(1.29to3.76,0.004),2.54(1.53to4.22,<0.001) for men and women, respectively, compairing subjects in group3to those in goup1. The associations remained statistically significant after additional adjustment for history of hypertension, history of coronary heart disease, history of stroke, history of malignancy, current smoker, current alcohol use, physical inactivity, educational status. The odd ratio for CKD were2.30(95%CI1.28to4.12, P=0.005) in male subpopulation. The odd ratio for CKD were2.24(95%CI1.28to3.92, P=0.005) in female subpopulation. The relationship between HW phenotype and CKD persists even after adjustment for diabetes and hypertension, although they were attenuated in women. The odd ratio was1.91(95%CI1.05to3.59, P=0.035). But the association was abolished when diabetes and hypertension were added to the model in male subpopulation(OR1.53,95%CI0.82to2.84, P=0.66).Association between Non-alcoholic Fatty Liver Disease and Chronic Kidney Disease in Population with Prediabetes or Diabetes.There were334participants have diabetes or prediabetes. we excluded participants consisted of115subjects who without a liver ultrasound examination,8male have fatty liver disease but with ethanol intake exceed20g/d,21participants serum creatinine or urinary albumin missing. Finally, the remaining190participants meet our criterion and enrolled our study. Among those participants127with NAFLD,63without NAFLD. The mean age is59.45±10.70.Baseline Characteristics of non-NAFLD and NAFLD subgroupsParticipants with NAFLD were more likely with a higher prevalence of history hypertension, higher systolic blood pressure, diastolic blood pressure, higher BMI or higher waist circumference (P<0.05). Those with NAFLD also had moderately higher serum triglyceride, higher serum c-reactive protein, higher serum uric acid, higher fasting glucose, higher urinary albumin to creatinine ratio, and higher HOMA-IR (P<0.05). CKD were common among patients with NAFLD than among those without NAFLD (P<0.05). While, age, sex, history of coronary heart disease, education status (≥high school), current smoking, serum creatinine did not differ between the groups.Prevalence of CKD in subjects with or without NAFLDA higher prevalence of CKD was found in subjects with NAFLD than those without NAFLD (32.3%vs17.5%, p<0.05).Baseline Characteristics of non-CKD and CKD subgroupsParticipants with CKD were more likely older, with higher blood pressure, with higher density lipoprotein, higher fasting glucose than those with non-CKD. Participants with CKD were more likely to have higher prevalence of NAFLD than those without CKD (P=0.031).Association of ultrasound-diagnosed NAFLD and CKDNAFLD was associated with CKD in the unadjusted analyses. The odd ratio was2.25(95%CI1.07-4.77, p=0.034). Further adjustment for age, sex, high school or above, current smoking and physical inactivity, NAFLD was still significantly associated with CKD. The odd ratio was2.68(95%CI1.12-6.01, P=0.016). When further adjusted for hypertension, serum high density lipoprotein and serum fasting glucose, the association of NAFLD and CKD was still significant (OR2.78,95%CI1.03-7.52, P=0.044).CONCLUSIONSOur study showed that MS was associated with presence of CKD in the Southern Chinese population, which may provide important information for the epidemiological control of these diseases. Further studies are warranted for the causal relationship between MS and CKD. Our study explored the association between MS and CKD in perimenopausal women.We found a significant relationship only for community perimenopausal women aged from50or older to60. Further studies are warranted to elucidate the causal relationship between the metabolic syndrome and CKD in perimenopausal women aged from50or older to60. The possible impact of sex hormones on the relationship between MS (it’s components) and CKD in perimenopausal women, likewise warrants further investigation.Our study showed that the HW phenotype was associated with the presence of CKD in the population aged40years and older, from which we can speculate that the HW phenotype might be considered as a simple, yet sensitive marker for identifying adults at risk of CKD in the population aged40years and older.Our results suggested that both VAI and the HW phenotype were significantly associated with CKD in female. But VAI was not associated with CKD in male. Though VAI and the HW phenotype are both effective markers of visceral obesity, the HW phenotype might be a better predictor of CKD in Chinese men and women. Our finding demonstrated that a positive association between ultrasonographic NAFLD and CKD in population with diabetes or prediabetes.