| Clinical studies show that cardiovascular risk factors, such as essential hypertension, diabetes, dyslipidemia and obesity, may effect on renal dysfunction. In fact, it has been reported that hypertension and diabetes are the most common cause of end stage renal disease in patients with chronic kidney disease. However the cluster of these risk factors often assembled with the same patient. This was identified as metabolic syndrome (MS) by WHO in 1999. The prevalence of MS and its cardiovascular complication is incredibly increasing in the past decades. Every composition of MS could lead to the cardiovascular disease, and the cluster of many risk factors would be more susceptible to the cardiovascular disease. Although it has recently been found that the presence of renal dysfunction is associated with high cardiovascular morbidity and mortality in patients with hypertension or diabetes, the relationship between mild renal dysfunction and cardiovascular remodeling is still unclear. The change of mild renal dysfunction in MS was rarely reported. This study aim to investigate the characteristics of renal dysfunction in the MS subjects and its role in cardiovascular remodeling to provide an opportunity to prevent or delay damage of kidney and reduce cardiovascular events in MS.Subjects and Methods1. SubjectsSix hundred and nineteen patients aged 38-80 years old (male 320, and female 299) were divided into three groups. 1) Essential hypertension (EH, 144); 2) Diabetes mellitus (DM, 134); 3) Metabolic syndrome (MS, 341). The MS definition was suggested by a working group consulted by the WHO in 1999 (glucose intolerance or insulin resistance or diabetes together with 2 or more the following risk factors: BP 140/90 mmHg; TG>1.7, and/or HDL-C < 0.9 mmol/L; BMI 25; microalbuminuria).2. MethodsAll patients were collected venous blood to assay fasting glucose, fasting insulin,fasting total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr),uric acid (UA) and free fatty acid (FFA).Urinary albumin excretion (UAE) and urinary creatinine were detected and creatinine clearance value by calculation of the computer. Some patients were observed by Color Doppler echocardiography. The intima-media thickness(IMT) were measured. At left ventricular diastole period end point, left ventricle inner diameter (LV), left ventricular posterior wall thickness (LVPW) and interventricular septum thickness (IVS) were messureed, then calculated left ventricular mass (LVM) according to Dereveux formula.Results1. Urinary albumin excretion was significantly higher in MS compared with DM and EH (P<0.05) and creatinine clearance value was significantly decreased in MS compared with DM and EH (P<0.05).2. The prevalence of microalbuminuria, proteinuria, mild abnormal creatinine clearance and elevate serum creatinine values was significantly higher in MS compared with DM and EH(P<0.05).3. The prevalence of microalbuminuria, proteinuria, mild abnormal creatinine clearance and elevate serum creatinine values in patients with MS by controlling blood pressure or blood glucose and lipid in normal level was significantly decrease compared with that abnormal level of blood pressure or blood glucose and lipid in patients with MS (P<0.05).4. In patient with MS and EH, the value of IVS, LVPW, LVM, LVMI in groups of mild renal dysfunction increased significantly compared with normal renal function group respectively; furthermore, among groups of EH, DM and MS, the prevalence of LVH in patients with mild renal dysfunction was all significantly higher compared with patients with normal renal function. Moreover, with increasing the level of Cr, the value of IVS, LVPW, LVM, LVMI and IMT was also increased, especially in patients with MS.5. UAE or Cr was significantly correlated with IMT and LVMI only in patients with mild renal dysfunction. (P<0.05). It has no relationship between UAE or Cr and LVMI in patients with normal renal fun...
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