Clinical and Experimental Nephrology

, Volume 15, Issue 4, pp 560–566

Risk factors for metabolic syndrome in stable Italian renal transplant patients

  • Fabio Fabbian
  • Maurizio Bergami
  • Christian Molino
  • Alfredo De Giorgi
  • Marco Pala
  • Carlo Longhini
  • Francesco Portaluppi
Original Article

Abstract

Background

The prevalence of metabolic syndrome (MS) in renal transplant recipients (RTR) is still under investigation.

Methods

We performed a cross-sectional study of 107 stable RTR who were diagnosed as having MS defined by the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) criteria. Anthropometric, clinical and biochemical data were collected.

Results

Mean age of the patients studied was 55 ± 11 years (72 male, 35 female), dialysis duration before transplantation 30 ± 31 months, time since transplantation 42 ± 13 months. Mean serum creatinine was 1.68 ± 0.64 mg/dl; creatinine clearance by Cockcroft–Gault formula 53 ± 20 ml/min, glomerular filtration rate by 4-variable MDRD formula 48 ± 18 ml/min/1.73 m2. Thirty-seven patients (34.5%) had MS. The MS patients had higher weight (76 ± 13 vs. 68 ± 12 kg, p = 0.0033), body mass index (BMI) (26 ± 4 vs. 24 ± 3 kg/m2, p = 0.0025), waist circumference (101 ± 11 vs. 90 ± 11 cm, p < 0.0001), prevalence of BMI >25 k/m2 (57 vs. 34%, p = 0.0254), prevalence of diabetes mellitus before transplantation (8 vs. 0%, p = 0.0157), glycaemia (104 ± 31 vs. 87 ± 11 mg/dl, p = 0.0002), and triglyceridaemia (225 ± 105 vs. 112 ± 35 mg/dl, p < 0.0001). They also showed lower levels of high-density lipoprotein cholesterol (48 ± 15 vs. 68 ± 17 mg/dl, p < 0.0001). Multiple logistic regression analysis showed that only BMI was independently associated with MS (OR 1.21, 95% CI 1.06–1.37, p = 0.0037).

Conclusions

MS according to NCEP-ATP III criteria appears to be present in about one-third of RTR, and even small increases in BMI above 25 kg/m2 may determine the presence of MS in these patients. Therefore the preventive value of lifestyle modifications is very important for such patients, in order to strictly maintain body fat accumulation within the normal range.

Keywords

Metabolic syndrome Body mass index Renal transplant recipients Renal graft function 

References

  1. 1.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Manson JE, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Monson RR, Speizer FE, Hennekens CH. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990;322:882–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Lindholm A, Albrechtsen D, Frödin L, Tufveson G, Persson NH, Lundgren G. Ischemic heart disease − major cause of death and graft loss after renal transplantation in Scandinavia. Transplantation. 1995;60:451–7.PubMedCrossRefGoogle Scholar
  5. 5.
    de Mattos AM, Prather J, Olyaei AJ, Shibagaki Y, Keith DS, Mori M, Norman DJ, Becker T. Cardiovascular events following renal transplantation: role of traditional and transplant-specific risk factors. Kidney Int. 2006;70:757–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415–28.PubMedCrossRefGoogle Scholar
  7. 7.
    Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004;291:844–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med. 2004;140:167–74.PubMedGoogle Scholar
  9. 9.
    Soveri I, Abedini S, Holdaas H, Jardine A, Eriksson N, Fellström B. Metabolic syndrome and cardiovascular risk in renal transplant recipients: effects of statin treatment. Clin Transplant. 2009;23:914–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Levey AS, Greene T, Kusek JW, Beck GL, MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11:155A (abstract).Google Scholar
  12. 12.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without the use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.PubMedGoogle Scholar
  13. 13.
    Anonymous. Third Report of the National Cholesterol Education program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–421.Google Scholar
  14. 14.
    Ford ES. Prevalence of metabolic syndrome defined by the International Diabetes Federation among adults in the US. Diabetes Care. 2005;28:2745–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson CP, Gallagher-Lepak S, Zhu YR, Porth C, Kelber S, Roza AM, Adams MB. Factors influencing weight gain after renal transplantation. Transplantation. 1993;56:822–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41:480–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Holley JL, Shapiro R, Lopatin WB, Tzakis AG, Hakala TR, Starzl TE. Obesity as a risk factor following cadaveric renal transplantation. Transplantation. 1990;49:387–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Meier-Kriesche HU, Vaghela M, Thambuganipalle R, Friedman G, Jacobs M, Kaplan B. The effect of body mass index on long-term renal allograft survival. Transplantation. 1999;68:1294–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002;73:70–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Armstrong KA, Campbella SB, Hawleya CM, Nicolb DL, Johnson DW, Isbela NM. Obesity is associated with worsening cardiovascular risk factor profiles and proteinuria progression in renal transplant recipients. Am J Transplant. 2005;5:2710–8.PubMedCrossRefGoogle Scholar
  21. 21.
    el-Agroudy AE, Wafa EW, Gheith OE, Shehab el-Dein AB, Ghoneim M. Weight gain after renal transplantation is a risk factor for patient and graft outcome. Transplantation. 2004;77:1381–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Porrini E, Delgado P, Bigo C, Alvarez A, Cobo M, Checa MD, Hortal L, Fernández A, García JJ, Velázquez S, Hernández D, Salido E, Torres A. Impact of metabolic syndrome on graft function and survival after cadaveric renal transplantation. Am J Kidney Dis. 2006;48:134–42.PubMedCrossRefGoogle Scholar
  23. 23.
    de Vries AP, Bakker SJ, van Son WJ, van der Heide JJ, Ploeg RJ, The HT, de Jong PE, Gans RO. Metabolic syndrome is associated with impaired long-term renal allograft function; not all component criteria contribute equally. Am J Transplant. 2004;4:1675–83.PubMedCrossRefGoogle Scholar
  24. 24.
    DeFronzo RA, Ferrannini E. Insulin resistance: a multifaced syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14:173–94.PubMedCrossRefGoogle Scholar
  25. 25.
    Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE. Body weight and mortality among women. N Engl J Med. 1995;333:677–85.PubMedCrossRefGoogle Scholar
  26. 26.
    Rexrode KM, Buing JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord. 2001;25:1047–56.PubMedCrossRefGoogle Scholar
  27. 27.
    Festa A, D’agostino R Jr, Howard G, Mykkanene L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000;102:42–7.PubMedGoogle Scholar
  28. 28.
    Sattar N, Gaw A, Scherbakova O, Ford I, O’Reilly DS, Haffner SM, Isles C, MacFarlane PW, Packard CJ, Cobbe SM, Sheppard J. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in West of Scotland Coronary Prevention Study. Circulation. 2003;108:414–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Farin HM, Abbassi F, Reaven GM. Comparison of body mass index versus waist circumference with the metabolic changes that increase the risk of cardiovascular disease in insulin-resistant individuals. Am J Cardiol. 2006;98:1053–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Meigs JB, Wilson PWF, Fox CS, Vasan RS, Nathan DM, Sullivan LM, D’Agostino RB. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–12.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2011

Authors and Affiliations

  • Fabio Fabbian
    • 1
  • Maurizio Bergami
    • 2
  • Christian Molino
    • 1
  • Alfredo De Giorgi
    • 1
  • Marco Pala
    • 1
  • Carlo Longhini
    • 1
  • Francesco Portaluppi
    • 1
    • 3
  1. 1.Department of Clinical and Experimental MedicineUniversity Hospital “St. Anna”, University of FerraraFerraraItaly
  2. 2.Renal UnitUniversity Hospital “St. Anna”FerraraItaly
  3. 3.Hypertension CenterUniversity Hospital “St. Anna”FerraraItaly

Personalised recommendations