Metabolic Syndrome Rather than Obesity Alone Is More Significant for Kidney Disease

  • Samir I. Bagasrawala
  • Harsh Sheth
  • Hemal Shah
  • Rais Ansari
  • Muffazal Lakdawala
Original Contributions



Obesity is associated with metabolic syndrome, nonalcoholic steatohepatitis, and kidney disease. BMI may not be the ideal measure of obesity when used to assess its effect on kidney disease as it does not discriminate for age, sex, ethnicity, muscle, bone, or fat mass.


To assess the prevalence microalbuminuria and identify independent risk factors for development of kidney disease in the obese Indian population.


Age, weight, BMI, total body fat percentage, waist-to-hip ratio, hypertension, urinary albumin-to-creatinine ratio (UACR), and HbA1c were collected from 568 obese patients, presenting for bariatric surgery. Multivariate binary logistic regression was used to identify independent risk factors for kidney disease.


A total of 114 out of 568 (20.07%) obese patients had microalbuminuria (UACR range 30–283 μg/mg). HbA1C levels ≥ 6 (p = 0.01) and hypertension (p = 0.03) were the strongest independent variables for microalbuminuria. 14.67% with a BMI < 35 kg/m2, 21.30% with a BMI 35–50 kg/m2, and 19.44% with a BMI > 50 kg/m2 had microalbuminuria. Increasing BMI however was not statistically significant (p = 0.75). Total body fat percentage (p = 0.51), waist-to-hip ratio (p = 0.96), age (p = 0.30), sex (p = 0.38), and BMI (p = 0.75) were found to be statistically insignificant.


Kidney disease afflicts 1/5th of the obese Indian patients studied. Diabetes and hypertension remained as the most significant risk factors, while age, weight, increasing BMI, waist-to-hip ratio, or increasing body fat were found to be statistically insignificant for development and progression of kidney disease.


Microalbuminuria UACR Kidney disease Obesity BMI Total body fat percentage WHR Age Sex Weight Prevalence Risk factors Central obesity T2DM Hypertension Metabolic syndrome 



We would like to thank Dr. V. P. D’sa, Director, Medical Affairs, and Dr. Iqbal Bagasrawala, Associate Director, Medical Affairs of Saifee Hospital, for providing us with the platform to conduct this study.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Geneva: WHO. [accessed on November 28, 2012]. World Health Organization (WHO). 2012. World health statistics 2012.Google Scholar
  2. 2.
    Rutkowski P, Klassen A, Sebekova K, et al. Renal disease in obesity: the need for greater attention. J Ren Nutr. 2006;16(3):216–23.CrossRefGoogle Scholar
  3. 3.
    Wiggins KJ, Johnson DW. The influence of obesity on the development and survival outcomes of chronic kidney disease. Adv Chronic Kidney Dis. 2005;12(1):49–55.CrossRefGoogle Scholar
  4. 4.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–7.CrossRefGoogle Scholar
  5. 5.
    Gerstein HC, Mann JFE, Pogue J, et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the heart outcomes prevention evaluation study. Diabetes Care. 2000;23(supplement 2):B35–9.Google Scholar
  6. 6.
    Cao JJ, Barzilay JI, Peterson D, et al. The association of microalbuminuria with clinical cardiovascular disease and subclinical atherosclerosis in the elderly: the Cardiovascular Health study. Atherosclerosis. 2006;187(2):372–7.CrossRefGoogle Scholar
  7. 7.
    Praga M, Morales E. Obesity, proteinuria and progression of renal failure. Curr Opin Nephrol Hypertens. 2006;15(5):481–6.CrossRefGoogle Scholar
  8. 8.
    Chen H-M, Liu Z-H, Zeng C-H, et al. Podocyte lesions in patients with obesity-related glomerulopathy. Am J Kidney Dis. 2006;48(5):772–9.CrossRefGoogle Scholar
  9. 9.
    Sarafidis PA, Ruilope LM. Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol. 2006;26(3):232–44.CrossRefGoogle Scholar
  10. 10.
    Agrawal V, Shah A, Rice C, et al. Impact of treating the metabolic syndrome on chronic kidney disease. Nat Rev Nephrol. 2009;5(9):520–8.CrossRefGoogle Scholar
  11. 11.
    Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J. 2008;29(24):2959–71.CrossRefGoogle Scholar
  12. 12.
    Ix JH, Sharma K. Mechanisms linking obesity, chronic kidney disease, and fatty liver disease: the roles of fetuin-A, adiponectin, and AMPK. JASN. 2010;21(3):406–12.CrossRefGoogle Scholar
  13. 13.
    Yano Y, Hoshide S, Ishikawa J, et al. (2007) Differential impacts of adiponectin on low- grade albuminuria between obese and nonobese persons without diabetes. J Clin Hypertens (Greenwich) 9(10):775–782. [Epub 2007/10/06]Google Scholar
  14. 14.
    Cannon CP, Kumar A. Treatment of overweight and obesity: lifestyle, pharmacologic, and surgical options. Clin Cornerstone. 2009;9(4):55–68. (discussion 9–71)CrossRefGoogle Scholar
  15. 15.
    McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337:382–6.CrossRefGoogle Scholar
  16. 16.
    Raji A, Seely EW, Arky RA, et al. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab. 2001;86:5366–71.CrossRefGoogle Scholar
  17. 17.
    Chandie Shaw PK, Baboe F, van Es LA, et al. South Asian type 2 diabetic patients have higher incidence and faster progression of renal disease compared with Dutch European diabetic patients. Diabetes Care. 2006;29:1383–5.CrossRefGoogle Scholar
  18. 18.
    Herrera-Valdes R, Almaguer M, Chipi J, et al. Prevalence of obesity and its associ- ation with chronic kidney disease, hypertension and diabetes mellitus. Isle of Youth Study (ISYS), Cuba. MEDICC Rev. 2008;10(2):14–20.Google Scholar
  19. 19.
    KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12–154.Google Scholar
  20. 20.
    World Health Organisation. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii. 1–253Google Scholar
  21. 21.
    Bonnet F, Marre M, Halimi JM, et al. Waist circumference and the metabolic syndrome predict the development of elevated albuminuria in non-diabetic subjects: the DESIR study. J Hypertens. 2006;24:1157–63.CrossRefGoogle Scholar
  22. 22.
    Chen F, Yang W, Weng J, et al. Albuminuria: prevalence, associated risk factors and relationship with cardiovascular disease. J Diabetes Investig. 2014;5(4):464–71.CrossRefGoogle Scholar
  23. 23.
    Tapp RJ, Shaw JE, Zimmet PZ, et al. Albuminuria is evident in the early stages of diabetes onset: results from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Am J Kidney Dis. 2004;44:792–8. Scholar
  24. 24.
    Afkhami-Ardekani M, Modarresi M, Amirchaghmaghi E. Prevalence of microalbuminuria and its risk factors in type 2 diabetic patients. Indian J Nephrol. 2008;18(3):112–7.CrossRefGoogle Scholar
  25. 25.
    Liese A, Hense H, Döring A, et al. Microalbuminuria, central adiposity and hypertension in the non-diabetic urban population of the MONICA Augsburg survey 1994/95. J Hum Hypertens. 2001;15:799–804. Scholar
  26. 26.
    Atta MI, Abdalla NH, Ibrahim AA. Microalbuminuria and adiponectin in obese nondiabetic nonhypertensive people. Egypt J Obes Diabetes Endocrinol 2016;2:156–62Google Scholar
  27. 27.
    Ferris M. Obesity, albuminuria, and urinalysis findings in US young adults from the Add Health Wave III study. Clin J Am Soc Nephrol. 2007;2(6):1207–14.CrossRefGoogle Scholar
  28. 28.
    Kenealy T, Elley CR, Collins JF, et al. Increased prevalence of albuminuria among non-European peoples with type 2 diabetes. Nephrol Dial Transplant. 2012;27(5):1840–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Minimally Invasive Surgical Sciences and ResearchSaifee HospitalMumbaiIndia
  2. 2.MumbaiIndia
  3. 3.Department of MedicineSaifee HospitalMumbaiIndia

Personalised recommendations