Metabolic syndrome loses its predictive power in late-stage chronic kidney disease progression--a paradoxical phenomenon

Clin Nephrol. 2011 Feb;75(2):141-9. doi: 10.5414/cnp75141.


Background: Metabolic syndrome (MS) is a significant determinant of CKD. The aim of this study was to determine the possible impact of MS on CKD progression.

Methods: 746 CKD subjects were included. The presence of MS was determined according to the modified criteria proposed by the Adult Treatment Panel (ATP) III. The study endpoints were stage-to-stage CKD progression or starting renal replacement therapy during the study period. CKD Stages 1, 2 and 3 were defined as early-stage CKD, while CKD Stages 4 and 5 were defined as late-stage CKD.

Results: Early-stage CKD patients with MS had a higher risk of CKD progression than those without MS. Cox regression analysis showed that MS was a significant determinant of CKD progression in early-stage (HR: 1.60, p=0.041) but not late-stage CKD patients (HR: 1.00, p=0.975). The results of subgroup analysis in non-diabetic subjects also showed that only early-stage CKD subjects with MS had significant risks of CKD progression (HR: 2.21, p=0.010). In diabetic patients, the association between MS and CKD progression was not significant in both early- and late-stage CKD.

Conclusions: Our findings suggested that the impact of MS on CKD progression might be prominent in non-diabetic early-stage CKD subjects, and became non-significant in diabetic late-stage CKD and diabetic CKD patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Chi-Square Distribution
  • Chronic Disease
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / etiology*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / therapy
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Diseases / blood
  • Kidney Diseases / etiology*
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / complications*
  • Metabolic Syndrome / physiopathology
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Replacement Therapy
  • Risk Assessment
  • Risk Factors
  • Taiwan
  • Time Factors


  • Biomarkers