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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 22  |  Issue : 5  |  Page : 949-954
Prevalence of chronic kidney disease in adults with metabolic syndrome


1 Department of Human Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State; Renal Unit, Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
2 Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
3 Renal Unit, Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

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Date of Web Publication6-Sep-2011
 

   Abstract 

The burden of chronic kidney disease (CKD) and other non- communicable diseases continues to rise globally, and recent studies suggest that metabolic syndrome (MS) may add to this burden by contributing to the development of CKD. Given that reports on the prevalence of CKD in patients with MS in this environment are scanty, this study was undertaken with the sole aim of determining the prevalence of CKD in subjects with MS as defined by the International Diabetes Federation (IDF) and the National Cholesterol Education Project Adult Treatment Panel III (NCEP ATP III). A total of 240 consenting adults (18-70 years) attending the general out- patient clinic of the General Hospital Okrika for various ailments were studied. Subjects were screened for MS as per the above- mentioned criteria. Estimated GFR (eGFR) was determined with Modification of Diet for Renal Disease (MDRD) formula and CKD was defined as eGFR less than 60 mL/min/1.73 m2 . Data was analyzed using SPSS version 12.0 and Epi info version 4.06d; P <0.05 was considered as significant. A total of 88 males and 152 females were screened for MS by both criteria. Eighty- four (35.0%) of 240 subjects had MS as defined by NCEP ATP III, while 85 (35.4%) had MS as defined by the IDF. The subjects were predominantly females, and mean age was between 54.74 ± 15.30 and 55.60 ± 14.81 years. Four of the 84 (4.8%) subjects with MS by NCEP ATP III definition had CKD while three of the 85 (3.5%) subjects with MS by IDF definition had CKD. Among subjects without MS by either definition, the prevalence of CKD was four of 140 (2.9%). Although the prevalence of CKD was higher among subjects with MS by ATP III compared with those with MS as defined by IDF and subjects without MS, the differences were not statistically significant (X2 = 0.14; P = 0.710). A comparison of MS subjects without CKD and those with CKD did not show any significant difference in age, waist circumference, body mass index, blood pressure, fasting blood glucose and lipid profile (P > 0.05). CKD was more common in subjects with MS compared with those without, although the difference was not statistically significant. The prevalence of CKD in subjects with MS in our study population did not differ significantly when the different MS definitions were employed.

How to cite this article:
Emem-Chioma P C, Siminialayi I M, Wokoma F S. Prevalence of chronic kidney disease in adults with metabolic syndrome. Saudi J Kidney Dis Transpl 2011;22:949-54

How to cite this URL:
Emem-Chioma P C, Siminialayi I M, Wokoma F S. Prevalence of chronic kidney disease in adults with metabolic syndrome. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Jun 24];22:949-54. Available from: http://www.sjkdt.org/text.asp?2011/22/5/949/84394

   Introduction Top


The rising burden of non- communicable diseases (NCDs), such as type 2 diabetes mellitus, metabolic syndrome (MS), hypertension, dyslipidemia and chronic kidney disease (CKD), has become an increasing public health concern globally. The World Health Organization (WHO) estimate for 2005 was that 61% of the deaths (35 million) and 49% of the global burden of diseases were attributable to NCDs, [1] and if this trend continues, NCDs will be responsible for 70% of the total global deaths and 56% of the global disease burden by 2030. [1]

There are several reports from USA, [2],[3],[4] China [5],[6] and Japan [7],[8] suggesting that MS might be an important factor in the cause of CKD. Reports on the prevalence of MS as well as that of CKD in patients with MS in Africa and, especially, Nigeria are grossly scanty. Presently, there are no reported nationwide prevalence rates for MS in Nigeria; however, the prevalence among type 2 diabetics has been reported as 25.2% [9] and 54.3%. [10] Among South African blacks with established coronary artery disease, a 60% prevalence rate was reported using the National Cholesterol Education Project Adult Treatment Panel III (NCEP ATP III) criteria and 57.5% using the International Diabetes Federation (IDF) criteria, [11] while in Arabs aged 40 years and older using ATP III a prevalence of 24.3% was recorded. [12] Fezau et al, [13] who claimed to be the first to publish prevalence rates in a Sub- Saharan African population, gave a prevalence of 1.8% (0.6-3.5) in rural women and 7.9% (5.6- 11.3) in their urban counterparts using the WHO criteria (P = 0.0001).

The few reports on CKD in patients with MS in sub- Saharan Africa include a study from the La Reunion island, [14] which reported that age- , gender- and geographical- adjusted odds ratio of clinical proteinuria significantly increased with the number of MS traits in a non- diabetic population. Another study from South Africa reported that there was a four- fold increase of albumin creatinine ratio (ACR) between those subjects without MS traits and those with four or more traits (P < 0.0001 and 0.021 before and after adjustments for age, sex, duration of hypertension and antihypertensive medications, respectively). [15]

Given the high burden of CRF in Nigeria, [16] and the paucity of reports on the prevalence of CKD in patients with MS, this endeavor was embarked upon with the sole aim of determining the prevalence of CKD in patients with MS as defined by the NCEP ATP III and IDF criteria.


   Materials and Methods Top


This study was approved by the Research Ethics Committee of the College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria.

Subjects

A total of 240 subjects who were at least 18 years old were involved in the study, and comprised adults who attended the general outpatient clinic of the hospital for various ailments. Potential subjects were educated on the goals of the study and the extent of their involvement in the study. Informed consent was then obtained from each subject. Pregnant women, subjects with obvious ascites and other forms of edema as well as subjects who could not stand for weight and height measurements were excluded. The study population consisted of 88 males and 152 females.

Data collection

The study was conducted between 8.00 am and 12 noon daily in the May and June of 2006. On arrival at the study venue, each subject was allowed to rest for 15 minutes and then a questionnaire designed for the study was filled out with the help of the researchers. History of smoking, physical activity, diet and alcohol consumption was taken. Personal and family medical history of obesity, hypertension, diabetes mellitus and renal disease was also obtained. The subject's history of leisure/voluntary exercise and occupation of the subject was used to assess his/her level of physical activity. The BMI was calculated by dividing measured body weight in kilograms by the height in meters squared, i.e. weight (kg)/height (m) 2 . Waist circumference (WC) of the subjects was determined using a measuring tape, and measurements were taken in centimeters around the waist at the level of the iliac crest in a horizontal plane, parallel to the floor.

Blood pressure was measured using the auscultatory method, with the subject sitting upright in a straight- back chair. A mercury sphygmomanometer (Accoson, Vale Road, London N4 1PS, UK) and a stethoscope (Littmann, 3M Health Care, St. Paul, MN 55144- 1000, USA) were used. The first Korotkoff sound (phase 1) was recorded as the systolic blood pressure and phase 5 was taken as the diastolic pressure. Average blood pressure readings based on records on at least two occasions were computed for this study.

Fasting plasma glucose was analyzed by the glucose oxidase method, total cholesterol by the cholesterol oxidase method and triglyceride by the lipase method. Serum creatinine was analyzed by the Jaffe method, estimated glomerular filtration rate (eGFR) was determined with modification of diet for renal disease (MDRD) formula and CKD was defined as eGFR less than 60 mL/min/1.73 m 2 .


   Statistical Analysis Top


The results obtained were analyzed using SPSS for windows software version 12.0 (SPSS Inc., Chicago, IL, USA) and EPI- INFO (CDC, Atlanta, GA, USA). Results are presented as mean ± SEM, percentages and tables.

Comparison was done with "t"test for continuous variables and Chi- square test for categorical variables, and P- values less than 0.05 were considered statistically significant.


   Results Top


A total of 240 subjects (88 males and 152 females) were screened for MS by NCEP ATP III and IDF criteria. Eighty- four (35.0%) of 240 subjects had MS as defined by NCEP ATP III, while 85 (35.4%) had MS as defined by the IDF. The characteristics of the subjects with metabolic syndrome by both definitions, which were predominantly females, are as shown in [Table 1].
Table 1: Comparison of demographic and clinical characteristics of subjects with metabolic syndrome by ATP III criteria with those by IDF.

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Four of 84 subjects (4.8%) with MS by ATP III had CKD while three of 85 subjects (3.5%) with MS by IDF definition had CKD. The characteristics of these subjects with CKD are as shown in [Table 2].
Table 2: Comparison of CKD prevalence and clinical characteristics of CKD subjects without metabolic syndrome, metabolic syndrome by IDF criteria and those by ATP III.

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In the study, among subjects without MS by either definition, the prevalence of CKD was four of 140 (2.9%). Their mean age was 36.37 ± 1.56 years, and they were all females with mean WC, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, high- density lipoprotein cholesterol, low- density lipoprotein cholesterol, triglyceride, fasting blood sugar, serum creatinine and eGFR of 80.09 ± 0.81 cm, 22.70 ± 0.32 kg/m 2 , 124.06 ± 1.63 mmHg, 74.99 ± 0.90 mmHg, 3.81 ± 0.10 mmol/L, 0.70 ± 0.03 mmol/L, 2.68 ± 0.09 mmol/L, 1.58 ± 0.67 mol/L, 4.55 ± 0.12 mmol/L, 63.98 ± 1.83 μmol/L and 161.94 ± 6.00 mL/ min/1.73 m 2 , respectively.

A comparison of characteristics of MS ATP III subjects with CKD and MS ATP III subjects without CKD are shown in [Table 3].
Table 3: Comparison of metabolic syndrome by ATP III subjects with CKD with those without CKD.

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   Discussion Top


In this cross- sectional study, the prevalence of CKD was 3.5% and 4.8% (P > 0.05) in patients with MS by IDF and ATP III definitions, respectively. Although the IDF definition identified more cases of MS in this study as previously reported by Lorenzo et al, [17] the ATP III definition identified more cases of CKD. Prevalence rate of CKD from this study is low compared with that reported in a Chinese population aged 40 years and older, in which participants with MS had a higher prevalence of CKD (15.4% vs 8.3%; P < 0.001) than those without MS. [6] It is also lower than the rates in a general Japanese population in which the age- and sex- adjusted 5- year cumulative incidence of CKD was significantly greater in subjects with than without MS (10.6% vs 4.8%; P < 0.01). [8] Although this study did not find any significant difference in the prevalence rate of CKD in patients with MS by both definitions, suggesting that both may confer a similar risk for CKD, findings in a Southeast Asian population suggest that ATP III definition was associated with increased risk of CKD while MS by IDF definition was not associated with an increased risk of CKD. Their results suggest that the relationship between CKD and MS in their population is highly dependant on the criteria used to define MS. [18]

It is important to also note that in subjects without MS by either definition, the prevalence of CKD was 2.9%. This may suggest that, in our patients, there may be some other important prevailing CKD risk factors that are non- metabolic in nature, especially in those without MS. This is more so when the lack of significant difference in WC, body mass index, fasting blood glucose and fasting serum lipids between the various groups found in this study is taken into account.

In Nigeria, apart from hypertension and diabetes mellitus, other common causes of chronic renal failure have been reported to include chronic glomerulonephritis, toxic nephropathy and obstructive uropathy. [19],[20]

This study also reports a preponderance of females with MS and CKD, contrary to the general finding of higher prevalence of CKD in males than in females. [16] This preponderance of females with CKD may not be unconnected to the preponderance of females in the study population.

In summary, we found a relatively low prevalence of CKD in our patients with MS compared with studies from elsewhere. The prevalence of CKD among MS (ATP III) patients was higher compared with MS (IDF) patients, but this difference was not statistically significant. This finding suggests that both ATP III and IDF definitions for MS are equally effecttive in identifying patients with CKD.

 
   References Top

1.Projections of mortality and burden of disease to 2030. Geneva (CH): World Health Organization; Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed December, 2008.  Back to cited text no. 1
    
2.Chen J, Muntner P, Hamm LL, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 2004;140:167- 74.  Back to cited text no. 2
    
3.Lea J, Cheek D, Thornley- Brown D, et al. Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans. Am J Kidney Dis 2008;51(5):732- 40.  Back to cited text no. 3
    
4.Lucove J, Vupputuri S, Heiss G, North K, Russell M. Metabolic syndrome and the development of CKD in American Indians: the Strong Heart Study. Am J Kidney Dis 2008;51 (1):21- 8.  Back to cited text no. 4
    
5.Chen J, Gu D, Chen CS, et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant 2007;22(4):1100- 6.  Back to cited text no. 5
    
6.Zhang L, Zuo L, Wang F, et al. Metabolic syndrome and chronic kidney disease in a Chinese population aged 40 years and older. Mayo Clin Proc 2007;82(7):822- 7.  Back to cited text no. 6
    
7.Tanaka H, Shiohira Y, Uezu Y, Higa A, Iseki K. Metabolic syndrome and chronic kidney disease in Okinawa, Japan. Kidney Int 2006;69(2):369- 74.  Back to cited text no. 7
    
8.Ninomiya T, Kiyohara Y, Kubo M, et al. Metabolic syndrome and CKD in a general Japanese population: the Hisayama Study. Am J Kidney Dis 2006;48(3):383- 91.  Back to cited text no. 8
    
9.Alebiosu CO, Odusan BO. Metabolic syndrome in subjects with type 2 diabetes mellitus. J Natl Med Assoc 2004;96(6):817- 21.  Back to cited text no. 9
    
10.Isezuo SA. Is high density lipoprotein cholesterol useful in diagnosis of metabolic syndrome in native Africans with type 2 diabetes? Ethn Dis 2005;15(1):6- 10.  Back to cited text no. 10
    
11.Ntyintyane LM, Panz VR, Raal FJ. The metabolic syndrome using the National Cholesterol Education Program and International Diabetes Federation definitions among urbanized black South Africans with established coronary artery disease. J Endocr Metab Diabetes South Africa 2007;12(1):6- 12.  Back to cited text no. 11
    
12.Harzallah F, Alberti H, Benkhalifa F. The metabolic syndrome in Arab population: a first look at the new International Diabetes Federation criteria. Diabetes Med 2006;23(4):441- 4.  Back to cited text no. 12
    
13.Fezau L, Balkau B, Kegne AP, Sobngwi E, Mbanya JC. Metabolic syndrome in a sub- Saharan African setting: central obesity may be the key determinant. Atherosclerosis 2007;193 (1):70- 6.  Back to cited text no. 13
    
14.La Réunion Diabetes (Redia) Study Group. High prevalence of chronic kidney disease La Réunion island and its association with the metabolic syndrome in the non- diabetic population: La Réunion Diabetes (REDIA) Study. Diabet Metab 2007;33(6):444- 52.  Back to cited text no. 14
    
15.Okpechi IG, Pascoe MD, Swanepoel CR, Rayner BL. Microalbuminuria and the metabolic syndrome in non- diabetic black Africans. Diabet Vasc Dis Res 2007;4(4):365- 7.  Back to cited text no. 15
    
16.Akinsola A, Adelekun TA, Arogundade FA, Sanusi AA. Magnitude of the problem of CRF in Nigerians. Afr J Nephrol 2004;8:24- 6.  Back to cited text no. 16
    
17.Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program -Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007;30:8- 13.  Back to cited text no. 17
    
18.Kitiyakara C, Yamwong S, Cheepudomwit S, et al. The metabolic syndrome and chronic kidney disease in a Southeast Asian cohort. Kidney Int 2007;71(7):693- 700.  Back to cited text no. 18
    
19.Akinsola W, Odesanmi WO, Ogunniyi JO, Ladipo GO. Diseases causing chronic renal failure in Nigerians: a retrospective study of 100 cases. Afr J Med Sci 1989;18:131- 5.  Back to cited text no. 19
    
20.Ojogwu LI. The pathological basis of end- stage renal disease in Nigerians: experience from Benin City. West Afr J Med 1990;9(3):193- 7.  Back to cited text no. 20
    

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Correspondence Address:
P C Emem-Chioma
Department of Human Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt
Nigeria
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