Association between management of metabolic syndrome and progression of early-stage chronic kidney disease: an observational cohort study

Figures & data

Figure 1. Data flow diagram.

Table 1. Baseline characteristics of chronic kidney disease patients with MetS (N = 162).

Variable	Controlled MetS (N = 97)	Uncontrolled MetS (N = 65)	p-Value
Demographic data
Age, years	64.43 ± 14.57	62.20 ± 13.33	0.325
Male, n (%)	49 (50.5)	36 (55.4)	0.631
Systolic blood pressure (mmHg)	128.15 ± 16.82	131.67 ± 14.76	0.173
Diastolic blood pressure (mmHg)	68.64 ± 10.52	70.70 ± 11.15	0.235
Height (cm)	159.58 ± 8.08	160.66 ± 8.71	0.473
Weight (kg)	61.83 ± 11.97	74.87 ± 13.28	<0.001**
Body mass index (kg/m^2)	24.20 ± 3.88	28.99 ± 4.47	<0.001**
Numbers of MetS criteria	1.74 ± 1.13	3.38 ± 0.96	<0.001**
Laboratory data
Serum creatinine (mg/dL)	0.91 ± 0.27	1.00 ± 0.27	0.066
Estimated glomerular filtration rate at baseline (eGFR1) (ml/min/1.73m^2)	90.11 ± 34.30	82.90 ± 22.65	0.138
Urine protein-to-creatinine ratio (mg/g)	0.35 ± 0.25	0.34 ± 0.48	0.865
Fasting blood glucose (mg/dL)	110.89 ± 34.83	139.13 ± 46.81	<0.001**
Glycosylated hemoglobin (%)	6.32 ± 1.44	7.00 ± 1.29	0.003*
Total cholesterol (mg/dL)	191.73 ± 39.46	198.55 ± 43.52	0.302
Triglyceride (mg/dL)	108.51 ± 60.61	203.49 ± 152.96	<0.001**
High density lipoprotein cholesterol (mg/dL)	49.04 ± 16.22	38.93 ± 10.76	<0.001**
Low density lipoprotein cholesterol (mg/dL)	109.86 ± 28.64	110.87 ± 32.51	0.836

Note: *p < 0.05, **p < 0.001.

Table 2. Demographic and biochemical data during follow-up visits.

Variable	Controlled MetS (N = 97)	Uncontrolled MetS (N = 65)	p-Value
Demographic data
Follow-up (months)	9.04 ± 3.83	8.61 ± 3.46	0.473
Systolic blood pressure (mmHg)	121.73 ± 17.11	132.03 ± 17.05	<0.001**
Diastolic blood pressure (mmHg)	67.89 ± 10.64	71.24 ± 11.57	0.060
Height (cm)	159.63 ± 8.08	160.53 ± 8.77	0.504
Weight (kg)	61.87 ± 12.23	74.92 ± 12.51	<0.001**
Body mass index (kg/m^2)	24.20 ± 4.01	29.08 ± 4.37	<0.001**
Numbers of MetS components	1.30 ± 0.74	3.67 ± 0.7	<0.001**
Associated disease
Diabetes mellitus (%)	38(39.2)	43(66.1)	0.001*
Hypertension (%)	51(52.6)	46(70.7)	0.023*
Coronary artery disease (%)	10(10.3)	7(10.7)	1.000
Laboratory data
Serum creatinine (mg/dL)	0.87 ± 0.22	0.93 ± 0.23	0.064
estimated glomerular filtration rate (eGFR2)  (ml/min/1.73m^2)	82.86 ± 22.33	69.21 ± 20.00	<0.001**
Urine protein-to-creatinine ratio (mg/g)	0.34 ± 0.33	0.32 ± 0.39	0.692
Fasting blood glucose (mg/dL)	110.29 ± 29.98	141.50 ± 45.21	0.800
Glycosylated hemoglobin (%)	6.20 ± 1.21	7.14 ± 1.28	<0.001**
Total cholesterol (mg/dL)	188.42 ± 34.62	190.32 ± 34.54	0.726
Triglyceride (mg/dL)	100.01 ± 51.50	207.20 ± 119.00	<0.001**
High density lipoprotein cholesterol (mg/dL)	52.72 ± 16.09	39.22 ± 9.94	<0.001**
Low density lipoprotein cholesterol (mg/dL)	107.13 ± 26.38	106.01 ± 29.43	0.800
Delta eGFR1–eGFR2 (ml/min/1.73m^2)	5.58 ± 16.02	12.11 ± 13.19	0.007*

Note: *p < 0.05, **p < 0.001.

Figure 2. Proportions of free progression to late stage chronic kidney disease (eGFR < 60 mL/min/1.73 m²) in the group of controlled MetS and the group of uncontrolled MetS. Rapid kidney function decline (RKFD) was defined as a >5% annual eGFR decline from baseline.

Figure 3. Proportions of free progression to late stage chronic kidney disease (eGFR < 60 mL/min/1.73 m²) in subgroups A, B, C and D. Rapid kidney function decline (RKFD) was defined as a >5% annual eGFR decline from baseline.

Figure 4. Cumulative population receiving medications in controlled MetS and uncontrolled MetS.

Table 3. Logistic regression models to identify independent variables associated with the development of late-stage chronic kidney disease.

Variables	Hazard ratio (95% CI)	p-Value
Model 1
Age	1.034 (1.004–1.064)	0.024*
Gender	0.608 (0.299–1.237)	0.170
Glycosylated hemoglobin	1.065 (0.845–1.343)	0.591
Diabetes	2.089 (0.970–4.498)	0.060
Obesity	1.023 (0.502–2.082)	0.951
Hypertension	2.208 (1.052–4.634)	0.036*
Proteinuria	1.714 (0.559–5.235)	0.346
Estimated glomerular filtration  rate at baseline	0.967 (0.937–0.998)	0.037*
Presence of MetS	3.279 (1.545–6.958)	0.002**
Model II
Age	1.037 (1.007–1.067)	0.014*
Gender	0.552 (0.288–1.218)	0.155
Glycosylated hemoglobin	1.032 (0.809–1.316)	0.801
Diabetes	1.966 (0.876–4.412)	0.101
Obesity	1.077 (0.497–2.330)	0.851
Hypertension	2.325 (1.071–5.051)	0.033*
Proteinuria	1.779 (0.569–5.563)	0.322
Estimated glomerular filtration  rate at baseline	0.964 (0.932–0.996)	0.029*
Subgroup A	1	–
Subgroup B	0.901 (0.315–2.577)	0.845
Subgroup C	2.552 (0.953–6.832)	0.062
Subgroup D	2.982 (1.287–6.908)	0.011*
Model III
Age	1.036 (1.005–1.069)	0.025*
Gender	0.589 (0.281–1.234)	0.161
Glycosylated hemoglobin	1.087 (0.846–1.398)	0.514
Diabetes	2.198 (0.993–4.865)	0.052
Obesity	1.058 (0.481–2.325)	0.889
Hypertension	2.149 (1.006–4.592)	0.048
Proteinuria	1.652 (0.513–5.316)	0.400
Estimated glomerular filtration  rate at baseline	0.968 (0.937–0.999)	0.046
Number of MetS components
0 component	1	–
1 component	0.777 (0.187–3.324)	0.729
2 components	0.959 (0.334–2.752)	0.938
3 components	2.898 (1.138–7.377)	0.026*
4 components	2.649 (1.006–6.966)	0.049*
Model IV
Age	1.035 (1.003–1.067)	0.031*
Gender	0.480 (0.228–1.008)	0.052
Glycosylated hemoglobin	1.073 (0.842–1.367)	0.570
Diabetes	1.907 (0.896–4.059)	0.094
Obesity	0.813 (0.422–1.567)	0.537
Hypertension	1.744 (0.917–3.493)	0.059
Proteinuria	1.298 (0.377–4.473)	0.679
Estimated glomerular filtration  rate at baseline	0.969 (0.938–1.001)	0.056
High density lipoprotein  cholesterol	1.028 (0.528–2.000)	0.935
Triglyceride	0.560 (0.261–1.201)	0.136

Notes: Parameters of model 2: −2LLR = 302.628, x² = 18.563, p = 0.019.

Parameters of model 1: −2LLR = 303.413, x² = 18.510, p = 0.009.

Parameters of model 2: −2LLR = 303.129, x² = 19.200, p = 0.050.

Parameters of model 2: −2LLR = 303.659, x² = 18.335, p = 0.017.

*p < 0.05, **p < 0.001.