Objective:
To analyze prevalence of metabolic syndrome (MS) in early phases of chronic kidney disease (CKD) and effect of its components on early renal impairment.
Design and Method:
In this survey 1003 farmers from continental, rural part of Croatia were enrolled (386 men; 617 women; average age 52(30-95); females were older(Mann-Whitney test:z=3,6;p < 0,001). After extended questionnaire and clinical exam, fasting blood was drawn and second morning urine sample was collected (for microalbuminuria (MA) and alpha1 microglobulinuria (α1MG). Blood pressure (BP) was measured following the ESH/ESC guidelinies, metabolic syndrome (MS) was defined according to the NCEP ATP III recommendations. Subjects were classified into the CKD stages groups according to the KDOQI classification.
Results:
In general rural population prevalence of MS was 22,6% (30% men, 70% women; p = 0,045). Prevalence of MS was significantly higher in subjects with CKD stage 3 as compared to the CKD stage 1 (χ2 = 4;p = 0,045) as well as in subjects with MA compared to those with normal values (χ2 = 5,85;p = 0,016), while there was no difference between subjects with elevated and normal values of α1MG (χ2 = 0,19;p = 0,662).
We observed significant difference between stages CKD 1 and 3 in BP (χ2 = 15,6;p < 0,001), waist circumference (WC) (χ2 = 26,8;p < 0,001), fasting blood glucose (FBG) (χ2 = 22;p < 0,001), triglycerdies (TG) (χ2 = 7,4;p = 0,024) and HDL level (χ2 = 0,621;p < 0,001).
Significant differences in BP, FBG, WC and TG were observed between subjects with MA in comparison with normal values (χ2 = 8,1;p = 0,004; χ2 = 23,2;p < 0,001; χ2 = 6,85;p = 0,009; χ2 = 9,0;p = 0,003, respectively). Multivariate age-adjusted OR for development of MA was significant for FBG and TG (OR 2(1,43–2,8);p < 0,001; OR 1,59(1,02–2,5);p = 0,043, respectively).
Only systolic BP was significantly associated with α1MG(χ2 = 2,59;p < 0,001) with multivariate age-adjusted OR for development of α1MG of 1,52 (1,01–2,28);p = 0,043.
Conclusions:
Prevalence of MS and its components increase with CKD stage. MS, and especially FBG and TG are risk factors for MA while systolic BP is a risk factor for proximal tubule damage i.e. α1MG.
