Metabolic Syndrome, ESRD, and Death in CKD
Metabolic Syndrome, ESRD, and Death in CKD
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DOI：
10.2215/cjn.09870912
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发表时间：
2013-06-01
影响因子：
9.8
通讯作者：
Nally, Joseph V., Jr.
中科院分区：
文献类型：
--
作者：
Navaneethan, Sankar D.;Schold, Jesse D.;Nally, Joseph V., Jr.
背景和目的以往的研究报道了代谢综合征、慢性肾脏病和蛋白尿之间的关系。本研究检测了代谢综合征及其组分与终末期肾病和3期和4期CKD患者死亡之间的关系（估计GFR=15-59 ml/min/1.73 m（2））。设计、设置、参与者和测量3期和4期CKD患者（n= 25，868）有代谢综合征相关数据并在我们的医疗保健系统中进行随访的患者使用基于电子病历的登记处进行识别。考克斯比例风险模型和竞争风险分析被用来研究代谢综合征，其组成部分之间的关联（血压升高、高密度脂蛋白胆固醇降低、血清甘油三酯升高、糖代谢受损和肥胖）、全因死亡率和终末期肾病，同时调整人口统计学、共病情况、相关药物的使用和肾功能。（n= 15，605）患有代谢综合征。在多变量校正分析中，在平均2.3年的随访中，代谢综合征的存在与ESRD风险增加相关（风险比=1.33，95%置信区间=1.08，1.64），但与死亡无关（风险比=1.04，95%置信区间=0.97，1.12）。在代谢综合征的各个组成部分中，糖代谢受损，甘油三酯升高，高血压与终末期肾病的风险增加，而低HDL胆固醇和糖代谢受损与较高的死亡风险相关。结论代谢综合征的存在与终末期肾病，但与3期和4期CKD患者死亡无关。
Background and objectives Previous studies reported an association between metabolic syndrome, incident CKD, and proteinuria. This study examined the associations between metabolic syndrome and its components with ESRD and death among those patients with stages 3 and 4 CKD (estimated GFR=15-59 ml/min per 1.73 m(2)).Design, setting, participants, & measurements Patients with stages 3 and 4 CKD (n=25,868) who had data relating to metabolic syndrome and were followed in our health care system were identified using an electronic medical record-based registry. Cox proportional hazards models and competing risk analyses were used to study the associations between metabolic syndrome, its components (elevated BP, low HDL cholesterol, elevated serum triglycerides, impaired glucose metabolism, and obesity), and all-cause mortality and ESRD while adjusting for demographics, comorbid conditions, use of relevant medications, and renal function.Results Sixty percent of the study population (n=15,605) had metabolic syndrome. In the multivariate-adjusted analysis, presence of metabolic syndrome was associated with an increased risk for ESRD (hazard ratio=1.33, 95% confidence interval=1.08, 1.64) but not death (hazard ratio=1.04, 95% confidence interval=0.97, 1.12) during a mean follow-up of 2.3 years. Among the individual components of metabolic syndrome, impaired glucose metabolism, elevated triglycerides, and hypertension were associated with increased risk for ESRD, whereas low HDL cholesterol and impaired glucose metabolism were associated with higher risk of death.Conclusions Presence of metabolic syndrome is associated with ESRD but not death in patients with stages 3 and 4 CKD.