| Part I Metabolic syndrome and its components associated withglomerular filtration rate in middle-aged and elderly in GuiyangObjective:To explore the relationship between metabolic syndrome(MS)and estimated glomerular filtration rate(eGFR).Methods:A total of 10,140 adults aged 40 years and older inhabitants participated in the epidemiological study(Risk Evaluation of Cancers in Chinese Diabetic Individuals,REACTION)of risk factors of type 2 diabetes in China.All the participants lived in Beijing road community of Guiyang urban areas were investigated from May 2010 to August 2010 by adopting stratified cluster sampling method.All subjects were asked to fulfill the questionnaires and had physical examination and oral glucose tolerance test(OGTT).The vein blood sample was drawn to measure serum creatinine(Cr),fasting plasma glucose(FPG),OGTT 2h PG,triglyceride(TG),high density lipoprotein cholesterol(HDL-C),fasting plasma insulin and glycosylated hemoglobin(Hb A1_C).The definition of metabolic syndrome in our study was modeled after the Third Report of The National Cholesterol Education Program(NCEP)-Adult Treatment Panel III(ATPIII).Decreased eGFR was defined as an estimated eGFR<60 ml/min/1.73m~2 as an estimated.Insulin resistance evaluated by homeostasis model assessment of insulin resistance(HOMA-IR).Results:1.The prevalence of eGFR less than 60 ml/min/1.73m~2were 3.0%and 1.2%in participants with and without metabolic syndrome(P<0.05).Age,body mass index(BMI),waist,systolic blood pressure(SBP),diastolic blood pressure(DBP),FBG,Cr,TG and prevalence of chronic kidney disease level increased;HDL-C and eGFR decreased significantly MS compared to those without MS(P<0.05).2.The prevalence of eGFR decreased with the increase of metabolic syndrome components,respectively is 0.56%,1.10%,1.50%,2.87%,1.50%(P<0.05).3.The multivariate-adjusted odds ratios[95%confidence interval(CI)]of chronic kidney disease(CKD)in participants with compared to those without the metabolic syndrome were 1.75(OR 1.75,95%CI:1.29～2.37 P<0.05).The multivariate-adjusted odds ratios[95%confidence interval(CI)]of MS,which were independently association with decreased eGFR,were with elevated blood pressure,higher TG,lower HDL-C and elevated FPG,their statistically odds ratios were 1.78(OR 1.78,95%CI:1.32～2.39,P<0.05),2.96(OR 2.96,95%CI:1.54～5.68,P<0.05),1.06(OR 1.06,95%CI:0.78～1.43,P>0.05)、1.59(OR 1.59,95%CI:1.10～2.30,P<0.05)and 1.22(OR 1.22,95%CI:0.89～1.68,P>0.05),respectively.4.Compared to participants without any components of the metabolic syndrome,the multivariate-adjusted odds ratios(95%CI)of CKD were 1.57(OR 1.57,95%CI:0.53～4.64,P>0.05)、1.93(OR 1.93,95%CI:0.69～5.43,P>0.05)、3.07(OR 3.07,95%CI:1.11～8.49,P<0.05),2.89(OR2.89,95%CI:1.02～7.25,P<0.05)for those with 1,2,3,and 4or 5 components,respectively.Conclusions:1.MS and its components significant associated with CKD.With the increase components of MS,the increase risk of eGFR decreased.The strength of association between MS and CKD increased as the number of components increased from three to five,especially.There is no doubt that controlling the metabolic abnormalities is very important.2.The occurrence of CKD might combine multiple risk factors of MS.Part II Increased Risk of Chronic Kidney Diseases in Patients withMetabolic Syndrome:A 3-year Prospective Cohort Study in GuiyangAbstractObjective:To investigate the relationship of metabolic syndrome(MS)and its components with incident chronic kidney disease(CKD)and rapid decline of estimated glomerular filtration rate(eGFR).Methods:A total of 10,140 adults participated in the epidemiological study(Risk Evaluation of Cancers in Chinese Diabetic Individuals,REACTION)of risk factors of type2 diabetes in China were followed up for 3 years,7,231 persons were enrolled in this study.All subjects were asked to fulfill the questionnaires and had physical examination and oral glucose tolerance test(OGTT).The vein blood sample was drawn to measure serum creatinine(Cr),fasting plasma glucose(FPG),OGTT 2h PG,triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting plasma insulin and glycosylated hemoglobin(Hb A1_C).The definition of metabolic syndrome in our study was modeled after the Third Report of The National Cholesterol Education Program(NCEP)-Adult Treatment Panel III(ATPIII).Decreased eGFR was defined as an estimated eGFR<60 ml/min/1.73m~2 as an estimated.and rapid decline of eGFR≥30%Insulin resistance evaluated by homeostasis model assessment of insulin resistance(HOMA-IR).Results:1.During the 3-year follow-up period,eGFR<60 ml/min/1.73m~2 developed in 172subjects(2.4%).Compared with the eGFR normal group,the age,BMI,waist circumference,blood pressure,FBG,TG,creatinine,Hb A1_C and HOMR-IR in the decline of eGFR group were significantly higher(all P<0.05).The prevalent of CKD were higher than the eGFR normal group(43.1%VS.26.7%,P<0.001).2.The age,BMI,waist circumference,blood pressure,FBG,TG,creatinine,Hb A1_C、HOMR-IR in the MS group were significantly higher than in the non-MS group(all P<0.05).Those who decreased eGFR had higher frequency of MS presence at baseline than those who did not(3.63%VS.1.91%,P<0.001).3.Compared with the non-MS,the adjusted odds ratios(ORs)of eGFR<60 ml/min/1.73 m~2 and rapid decline of eGFR were 1.64(OR 1.64,95%CI:1.20～2.25,P<0.05),1.23(OR 1.23 95%CI:1.05～1.43,P<0.05)and 2.09(OR 2.09,95%CI:1.30～3.3,P<0.05)respectively in MS group.4.The ORs for developing CKD in subjects with high TG,reduced HDL-C,and hyperglycemia were 1.67(OR:1.67;95%CI:1.22–2.27,P<0.05),1.50(OR:1.50;95%CI:1.10–2.05,P<0.05),and 1.39(OR:1.39;95%CI:1.02–1.91,P<0.05),respectively.5.With the increase in the number of MS components,the prevalent of CKD were1.42%,1.44%,2.80%,3.42%,and 4.03%(P<0.001),respectively.6.The risk for developing incident CKD was higher in the group with the highest HOMA-IR than the group with the lowest HOMA-IR(OR 1.83,95%CI:1.16～2.89,P<0.05).Conclusions:1.The risk of rapid decline of eGFR was also higher in subjects with MS than those without MS.2.Compared with lowest HOMA-IR,the risk for developing incident CKD was higher in the group with the highest HOMA-IR.The occurrence and development of CKD is closely related to insulin resistance. |
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