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Impact of treating the metabolic syndrome on chronic kidney disease

Nature Reviews Nephrology volume 5, pages 520–528 (2009)Cite this article

Abstract

The metabolic syndrome is defined by the concurrent presence of at least three metabolic disorders that are associated with an increased risk of cardiovascular disease and diabetes. Results from prospective and cross-sectional studies also point to an association between the metabolic syndrome and chronic kidney disease. Visceral obesity and insulin resistance are two important features of the metabolic syndrome that might explain renal injury. We reviewed the literature to examine whether treatment of the metabolic syndrome can favorably influence renal outcomes. Weight loss, regular exercise, and a low-calorie, low-fat diet are first-line treatments of the metabolic syndrome, yet few data are available to indicate that such lifestyle interventions can prevent or reverse renal damage. Similarly, results from few studies show little or no beneficial effect of blood pressure control, use of statins, fibrates, thiazolidinediones or metformin on renal parameters in patients with metabolic syndrome. The reasons for the lack of trials in this research field are also discussed. This Review identifies the need to improve understanding of the role of metabolic syndrome in chronic kidney disease, define consistent criteria for metabolic syndrome and perform clinical trials that analyze renal outcomes as primary end points.

Key Points

  • The metabolic syndrome is a constellation of metabolic risk factors that predict increased risks of cardiovascular disease and diabetes

  • In cross-sectional and longitudinal studies, the metabolic syndrome is associated with chronic kidney disease and microalbuminuria

  • Abdominal obesity and insulin resistance are widely considered to be key mechanisms of metabolic-syndrome-mediated renal damage

  • Limited studies demonstrate that treatment of the metabolic syndrome by way of lifestyle changes, pharmacotherapies, or both, can improve markers of renal function

  • Increased recognition of the metabolic syndrome and early intervention for this condition could improve cardiovascular and renal outcomes

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Figure 1: Mechanisms of metabolic-syndrome-induced renal injury and potential targeted treatments.
Figure 2: Changes in anthropometric, blood pressure, glycemic, lipid, inflammatory and renal parameters 1 year after bariatric surgery.73
Figure 3: Changes in median albumin:creatinine ratio 1 year after bariatric surgery in a single-center study of 94 adults with obesity.73

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Authors and Affiliations

  1. Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Varun Agrawal, Aashish Shah & Casey Rice

  2. Division of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA

    Barry A. Franklin

  3. Division of Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Peter A. McCullough

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Agrawal, V., Shah, A., Rice, C. et al. Impact of treating the metabolic syndrome on chronic kidney disease. Nat Rev Nephrol 5, 520–528 (2009). https://doi.org/10.1038/nrneph.2009.114

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