| IntroductionMetabolic syndrome and chronic kidney disease (CKD) increased rapidly worldwide, have become important public health problems, which caused much attention of clinical researches. Recent years, lots of epidemiological investigations have carried out to survey the prevalence of metabolic disease and CKD, and analyze the association between serum uric acid level, metabolic syndrome and chronic kidney. According to the results of surveys, metabolic disorder showed a high prevalence. Hypertension prevalence was more than20%, diabetes prevalence rate was as high as9.7%, and the prevalence of metabolic syndrome was from17%to30%. CKD prevalence was also at a higher rate. Several studies show that the prevalence of CKD was already more than11%, and the prevalence of CKD was as high as10.8%in our country, which means that each of the ten natural populations might suffer from CKD.There were many pathogenic factors of CKD. In the survey of CKD, chronic glomerulonephritis was the first factor of CKD in the past. Metabolic diseases such as diabetes, obesity and hypertension are known to be risk factors of kidney injury, and play an important role in the progression of CKD. Hypertension and diabetes have been the leading causes of CKD in the developed countries. Approximately40%of diabetic patients had some degree of CKD in the United States and about25.3%of patients with hypertension were reported to experience kidney injury. Obesity conferred a high susceptibility to CKD with a relative risk of1.77. The CKD prevalence In patients with metabolic syndrome was more than20%, which was much higher than that in the general population. Similarly, the prevalence of metabolic syndrome in patients with CKD was much higher than that in the general population. Therefore, metabolic diseases and CKD are reciprocal causation, mutual influence.Epidemiological surveys found that hyperuricemia is an independent risk factor for the metabolic syndrome and CKD, and the risk of metabolic syndrome and CKD increased with the level of blood uric acid. The relative risk of metabolic syndrome increased by2-5times, CKD risk increased about1.7times. It seems to that uric acid maybe a predict factor of metabolic syndrome and CKDThe prevalence of metabolic syndrome and CKD was unclear in Zhejiang province. An epidemiological survey studying the association between uric acid, CKD and metabolic syndrome had not been undertaken yet.Objective:The aim of our study was to estimate the prevalence of metabolic syndrome and CKD, and to analyze association between uric acid, CKD and metabolic syndrome in this area. Methods:A cross-sectional survey of12000-15000adults was conducted from October2009to June2012. Each participant was required to complete a set of standardized questionnaire (gender, age, culture degree, occupation, family income, living environment, eating habits, exercise intensity, medical history), physical examination, and blood and urine specimen collection. International standards were for diagnosis of chronic diseases. The prevalence of metabolic disease and chronic kidney disease were calculated, and association between uric acid, metabolic syndrome and CKD was analyzed. Analyses were done with SPSS.Result:A total number of14087adults completed the screening, and the completion rate was85.8%. The number of metabolic syndrome population was2656, the total prevalence rate was18.9%, the prevalence rate of male was10.2%, female prevalence was25.2%, with statistical differences between the male and female prevalence rate, P <0.0001. The number of CKD population was1880, the total prevalence rate was13.3%, the prevalence rate of male was11.6%, and14.7%in female, with statistical differences between the two groups a, P<0.0001. The prevalence of CKD in metabolic syndrome population was22%, and11.3%in non-metabolic syndrome population, the difference was significant, P<0.0001. The prevalence of CKD in metabolic syndrome subgroups was significantly higher than that in general population. In CKD patients, the prevalence of metabolic syndrome was31%, which was much higher than that in non-CKD crowd with the prevalence of metabolic syndrome (17%), the difference was significant (P<0.0001). Uric acid level in metabolic syndrome group was298±88.5μmol/L, which was higher than that of non-metabolic syndrome group with a uric acid level of277±86.2μmol/L. Metabolic syndrome prevalence rates in different levels of uric acid groups(Q1<220μmol/L), Q2(220-272μmol/L), Q3(272-332μmol/L),(Q4>332μmol/L) were:12.5%,19.8%,20.2%,22.8%, respectively, there were statistical differences, P<0.0001. The level of serum uric acid (Q1<220μmol/L) as a reference, the risk of metabolic syndrome were1.73,1.76,2.07. According to age, gender, smoking, alcohol consumption and serum creatinine, the adjusted risk was2.07,3.07,6.04; respectively. The risk in women increased respectively2.16,3.44,5.51, and the risk value is1.46,1.79,4.44in men. When eGFR>90ml/min, the relationship between metabolic syndrome and uric acid levels was much significant, the risk values were1.84(1.60-2.11),1.89(1.64-2.18),2.10(1.80-2.44). When eGFR was60-90ml/min, the risk values were1.08(0.74-1.59),1.31(0.92-1.87),1.76(1.26-2.48); When eGFR<60ml/min, there was no significant correlation between uric acid and metabolic syndrome. Uric acid and glomerular filtration rate were negatively correlated, the correlation coefficient r=0.242. Hyperuricemia is an independent risk factor of metabolic syndrome and CKD. When elevated serum uric acid level in metabolic syndrome patients, the prevalence of CKD increased, the risk were1.84(1.60-2.11),1.89(1.64-2.18),2.10(1.80-2.44), respectively, and the difference was significantly, P <0.0001. ROC curve was constructed to determine the discriminatory power of uric acid levels for diagnosis of metabolic syndrome. The area under ROC curve was low. Conclusion:The prevalence of metabolic syndrome and CKD were high in Zhejiang province, and the prevalence in female was much higher than that in male. Metabolic syndrome and metabolic disorders increased the risk of CKD. The risk of metabolic disorder occurs in patients with CKD increased. In the group with normal renal function, blood uric acid level used to indicate the metabolic syndrome has certain reference, but was not an accurate indicator in diagnosis of metabolic syndrome. |
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