Renal Function and Risk Factors of Moderate to Severe Chronic Kidney Disease in Golestan Province, Northeast of Iran

Introduction: The incidence of end-stage renal disease is increasing worldwide. Earlier studies reported high prevalence rates of obesity and hypertension, two major risk factors of chronic kidney disease (CKD), in Golestan Province, Iran. We aimed to investigate prevalence of moderate to severe CKD and its risk factors in the region. Methods: Questionnaire data and blood samples were collected from 3591 participants (≥18 years old) from the general population. Based on serum creatinine levels, glomerular filtration rate (GFR) was estimated. Results: High body mass index (BMI) was common: 35.0 of participants were overweight (BMI 25-29.9) and 24.5 were obese (BMI ≥30). Prevalence of CKD stages 3 to 5 (CKD-S3-5), i.e., GFR <60 mL/min/1.73 m2, was 4.6. The odds ratio (OR) and 95 confidence interval (95 CI) for the risk of CKD-S3-5 associated with every year increase in age was 1.13 (1.11- 1.15). Men were at lower risk of CKD-S3-5 than women (OR = 0.28; 95 CI 0.18-0.45). Obesity (OR = 1.78; 95 CI 1.04-3.05) and self-reported diabetes (OR = 1.70; 95 CI 1.00-2.86), hypertension (OR = 3.16; 95 CI 2.02-4.95), ischemic heart disease (OR = 2.73; 95 CI 1.55-4.81), and myocardial infarction (OR = 2.69; 95 CI 1.14-6.32) were associated with increased risk of CKD-S3-5 in the models adjusted for age and sex. The association persisted for self-reported hypertension even after adjustments for BMI and history of diabetes (OR = 2.85; 95 CI 1.77-4.59). Conclusion: A considerable proportion of inhabitants in Golestan have CKD-S3-5. Screening of individuals with major risk factors of CKD, in order to early detection and treatment of impaired renal function, may be plausible. Further studies on optimal risk prediction of future end-stage renal disease and effectiveness of any screening program are warranted. © 2010 Najafi et al

Metabolic syndrome and chronic kidney disease

Obesity is a global health threat because of its associated metabolic and cardiovascular complications. Metabolic and hemodynamic complications of obesity (insulin resistance and hyperglycemia, hypertension, atherogenic dyslipidemia) are often clustered in the metabolic syndrome, leading to high cardiovascular morbidity and mortality. In recent years, epidemiological studies have clearly indicated that both obesity and the metabolic syndrome are independent risk factors for chronic kidney disease and these associations are at least in part independent of diabetes and hypertension per se. Additional mechanisms associated with obesity and metabolic syndrome leading to reduced renal function may include altered levels of adipose tissue hormones, inflammation, and oxidative stress. The ongoing worldwide obesity epidemic is therefore likely to increase the number of patients with chronic uremia and features of the metabolic syndrome in the next few years. Moreover, the onset and maintenance of renal damage may worsen metabolic syndrome features including insulin resistance and hypertension, leading to potential vicious cycles with negative clinical effect. Further understanding of the interactions between obesity, metabolic syndrome, and chronic kidney disease represents a potential strategy to design more effective treatments aimed at reducing morbidity and mortality in uremic patients