Metabolic syndrome in haemodialysis patients: prevalence, determinants and association to cardiovascular outcomes

Abstract

Background: In the general population, metabolic syndrome (MetS) is predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is associated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear.

Methods: In a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE (coronary diseases, peripheral arteriopathy, stroke or cardiac failure), was studied using receiver operating characteristics (ROC) curves and logistic regression.

Results: A total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p < 0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24-2.75; p < 0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension.

Conclusions: MetS is frequent and significantly associated with MACE in our haemodialysis cohort and probably in other European dialysis populations as well. In HD patients, a new simplified definition could be proposed in keeping with the concept of the "hypertriglyceridaemic waist".

Keywords: Epidemiology; Haemodialysis; Major cardiovascular events; Metabolic syndrome; Waist circumference.

Fig. 1

Study flowchart

Fig. 2

ROC curves of the association between isolated MetS parameters and MetS. Legend: — Waist circumference, AUROC = 0.80. — HDL cholesterol, AUROC = 0.77. — TG, AUROC = 0.797. — Fasting glucose, AUROC = 0.70. AUROC: Area Under the ROC

Fig. 3

Distribution of MACE subtypes according to the presence or absence of metabolic syndrome. MetS: Metabolic syndrome. MACE: major adverse cardiovascular events. CHD: coronary heart disease. PAD III-IV: peripheral arterial disease, stage III or IV according to the classification of Leriche and Fontaine. HF: Heart failure. Significant difference (P < 0.05) between MetS+ and MetS- for CHD, PAD III-IV and HF; not significant for Stroke