Cardiometabolic Risk Factors, Metabolic Syndrome, and Chronic Kidney Disease Progression in Children

Abstract

Objective: To estimate the prevalence of metabolic syndrome (MetS) and examine its association with chronic kidney disease progression in children enrolled in the Chronic Kidney Disease in Children study.

Study design: MetS was defined as being overweight or obese and having ≥2 cardiometabolic risk factors (CMRFs). Incidence and prevalence of MetS were assessed using pairs of visits approximately 2 years apart.

Results: A total of 799 pairs of person-visits (contributed by 472 children) were included in the final analysis. Of these, 70% had a normal body mass index (BMI), 14% were overweight, and 16% were obese. At the first visit, the prevalence of MetS in the overweight group was 40% and in the obese group was 60%. In adjusted models, annual percent estimated glomerular filtration rate decline in those who had normal BMI and incident or persistent multiple CMRFs or those with persistent MetS was -6.33%, -6.46%, and -6.08% (respectively) compared with children who never had multiple CMRFs (-3.38%, P = .048, .045, and .036, respectively). Children with normal BMI and incident multiple CMRFs and those with persistent MetS had approximately twice the odds of fast estimated glomerular filtration rate decline (>10% per year) compared with those without multiple CMRFs and normal BMI.

Conclusion: Children with chronic kidney disease have a high prevalence of MetS. These children as well as those with normal BMI but multiple CMRFs experience a faster decline in kidney function.

Keywords: cardiovascular risk; children; chronic kidney disease; metabolic syndrome.

Figure 1

Description of the selection of participants and pairs of visits that contributed to the analytic study population. ¹CMRF: cardiometabolic risk factors ²Covariktes: CKD diagnosis, maternal education, gender, race. CKD duration (in years) and corticosteroid use

Figure 2

Distributions of the annual percent change of eGFR (as percentile boxplots) by categories of visit pairs stratified by BMI category at the index visit: free of metabolic syndrome, incident multiple cardiometabolic risk factors or metabolic syndrome, resolved cardiometabolic risk factors or metabolic syndrome, and persistent multiple cardiometabolic risk. • Indicate individual data points in which the group size is less than 20 pairs of person-visits. —— Indicate 10% or more decrease in eGFR per year; proportion below this threshold is shaded in grey