Metabolic Syndrome Severity and Risk of CKD and Worsened GFR: The Jackson Heart Study.

The metabolic syndrome (MetS), as assessed using dichotomous criteria, is associated with increased risk of future chronic kidney disease (CKD), though this relationship is unclear among African Americans, who have lower risk for MetS but higher risk for CKD. We performed logistic regression using a sex- and race-specific MetS-severity z-score to assess risk of incident CKD among 2,627 African-American participants of the Jackson Heart Study, assessed at baseline and 8 years later. Based on quartile of baseline MetS severity, we further assessed prevalence of being in the lowest quartile of baseline GFR, the lowest quartile of relative GFR at follow-up, microalbuminuria and incident CKD. Higher MetS-severity was associated with higher prevalence of GFR in the lowest quartile at baseline among males and females. Among African-American females but not males, higher baseline MetS-severity was associated with a higher prevalence of baseline elevations in microabuminuria (p<0.01), steep decline in GFR (p<0.001) and a higher incidence of CKD (p<0.0001). Women in increasing quartiles of baseline MetS-severity exhibited a linear trend toward higher odds of future CKD (p<0.05), with those in the 4th quartile of MetS-severity (compared to the 1st) having an odds ratio of 2.47 (95% confidence interval 1.13, 5.37); no such relationship was seen among men (p value for trend 0.49). MetS-severity exhibited sex-based interactions regarding risk for future GFR deterioration and CKD, with increasing risk in women but not men. These data may have implications for triggering CKD screening among African-American women with higher degrees of MetS-severity.

代谢综合征（MetS），采用二分法标准评估，与未来慢性肾脏病（CKD）风险增加相关，不过这种关系在非裔美国人中尚不明确，他们患代谢综合征的风险较低，但患慢性肾脏病的风险较高。 我们使用性别和种族特异性的代谢综合征严重程度z评分进行逻辑回归，以评估杰克逊心脏研究中2627名非裔美国参与者发生慢性肾脏病的风险，这些参与者在基线和8年后接受评估。基于基线代谢综合征严重程度的四分位数，我们进一步评估了处于基线肾小球滤过率（GFR）最低四分位数、随访时相对GFR最低四分位数、微量白蛋白尿和慢性肾脏病发生的患病率。 在男性和女性中，较高的代谢综合征严重程度与基线时处于GFR最低四分位数的患病率较高相关。在非裔美国女性而非男性中，较高的基线代谢综合征严重程度与基线微量白蛋白尿升高的患病率较高（p<0.01）、GFR急剧下降（p<0.001）以及慢性肾脏病发病率较高（p<0.0001）相关。基线代谢综合征严重程度四分位数逐渐升高的女性，未来患慢性肾脏病的几率呈线性上升趋势（p<0.05），代谢综合征严重程度处于第4四分位数的女性（与第1四分位数相比）优势比为2.47（95%置信区间1.13，5.37）；在男性中未观察到这种关系（趋势p值为0.49）。 代谢综合征严重程度在未来GFR恶化和慢性肾脏病风险方面表现出基于性别的交互作用，女性风险增加，男性则无。这些数据可能对在代谢综合征严重程度较高的非裔美国女性中启动慢性肾脏病筛查具有启示意义。