Risk of Chronic Kidney Disease in Non-Obese Individuals with Clustering of Metabolic Factors: A Longitudinal Study

Abstract

Objective The impact of the clustering of metabolic factors on chronic kidney disease (CKD) in non-obese individuals remains unclear. Methods We conducted a follow-up study of 23,894 Japanese adults (age, 18-69 years) who continuously received annual health examinations between 2000 and 2011. Obesity, high blood pressure, high triglycerides, low high-density lipoprotein (HDL) cholesterol and high fasting blood sugar were defined as metabolic factors, and CKD was defined as renal dysfunction (estimated glomerular filtration rate: <60 mL/min/1.73 m 2 ) or proteinuria (dipstick test: ! 1+). The association between the clustering of metabolic factors and CKD was assessed based on the presence or absence of obesity using a Cox proportional hazard model. Results Of 2,867 subjects with ! 3 metabolic factors, 650 (22.7%) were non-obese. These individuals were older and had higher metabolic risks than their obese counterparts at baseline. Among the entire cohort of 23,894 subjects, 1,764 developed renal dysfunction and 904 developed proteinuria during an average followup period of 7.8 years. The cumulative incidence of renal dysfunction was higher (22.1% vs. 16.1%), whereas that of proteinuria was lower (10.5% vs. 14.4%), among the non-obese subjects with ! 3 metabolic factors than the obese subjects with ! 3 metabolic factors after 11 years. The adjusted relative risk (RR) (95% confidence interval) of renal dysfunction was 1.54 (1.34-1.77) and 1.67 (1.35-2.07) for the obese and nonobese subjects with ! 3 metabolic factors, respectively. Conclusion Non-obese subjects with ! 3 metabolic factors, who are missed based on the essential criterion of obesity for metabolic syndrome, may have an equal or slightly higher risk of renal dysfunction than obese subjects with ! 3 metabolic factors.

Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies

“…[81][82][83] A total of 66 studies, comprising 699 065 CKD patients and 11 109 003 participants, were finally included in the meta-analysis. Among the included studies, 43 were from the East Asian populations 8,9,[22][23][24][25][27][28][29]33,[35][36][37][38][39][40][41]43,44,51,52,[55][56][57][58][59]62,[65][66][67]69,[71][72][73][74][75][76][77][78][79][80]82,83 and 23 were from non-East Asian populations. 12,20,21,26,[30...…”

“…The relationship between HDL-cholesterol level and CKD risk was examined in 45 studies, 9,12,21,23,24,[26][27][28][33][34][35][36][38][39][40]42,44,48,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][67][68][69][71][72][73][74][75][76]79,82,83 including 692 780 patients and 11 039 480 participants. In the overall analysis, the risk estimate for lower values of HDL-cholesterol, as compared with higher values, was 1.20 (95% CI = 1.11-1.30).…”

Influence of chronic kidney disease on hospitalization, chronic dialysis, and mortality in Japanese men: a longitudinal analysis

“…Another study revealed that aging, angina pectoris, and peripheral vascular disease served as predictors of hospitalization [25]. CKD patients are considered to be more likely to (1) have high prevalences of comorbidities (e.g., hypertension and diabetes) whose management is complex [4,11,13,26], (2) have high occurrence and recurrence rates of CVD, acute kidney injury, and infectious diseases [16,17], and (3) develop procedural accidents during hospitalization [27], which may be associated with an increase in the risk of hospitalization, particularly that of long-term hospitalization.…”

“…Thus, opportunities to identify CKD are limited. As suggested by recent studies conducted in Japan [14,26], GFR measurement should be widely conducted for more individuals, especially for those at high risk of CKD, in clinical practice and mass health examinations.…”

Prevalence of chronic kidney disease and associated metabolic risk factors in a middle-aged and elderly Taiwanese population: a cross-sectional study

“…Taiwan had the highest prevalence of end-stage renal disease (ESRD) in the world for more than a decade [1]. The prevalence of chronic kidney disease (CKD) is higher in older adults and reached 37.2% in elderly patients (age ≥ 65 years), while the prevalence of CKD is 11.93% in adults of all ages (age ≥ 20 years) in Taiwan [2]. Treatments for CKD have the greatest effects on slowing the rate of disease progression when started early.…”