Comparison of association of glomerular filtration rate with metabolic syndrome in a community-based population using the CKD-EPI and MDRD study equations

Background: Targeting metabolic syndrome (MetS) in early chronic kidney disease (CKD) is essential to reduce cardiovascular complications. We compared the association of kidney function estimated by two glomerular filtration rate (GFR) equations with MetS in community population. Methods: We analyzed 12,700 participants from 2009 to 2010 the Korea National Health Survey data. GFR was estimated using the CKD Epidemiology Collaboration equation (GFR(CKD-EPI)) and the Modification of Diet in Renal Disease study equation (GFR(MDRD)). Results: The prevalence of MetS increased from the highest GFR category (>105 ml/min/1.73 m(2)) to the lowest (<60 ml/min/1.73 m(2)) using both equations (GFR(CKD-EPI), 14.1% to 62.3%; GFR(MDRD), 18.4% to 62.9%). Participants reclassified to higher GFR(CKD-EPI) category (upward) from GFR(MDRD) had lower prevalence of MetS than those moved downward (Net reclassification improvement 13.7%, P < 0.001). Compared with GFR >= 105 ml/min/1.73 m(2), mildly impaired GFR(CKD-EPI) (75-89 ml/min/1.73 m(2)) was independently associated with increased odds of MetS (OR 1.30,95% Cl 1.09-1.56, P = 0.003) in multivariate analysis, whereas GFR(MDRD) was not (OR 1.08, 95% Cl 0.92-1.27, P = 0.344). Conclusions: Compared with GFR(MDRD), GFR(CKD-EPI) showed better association with prevalence of MetS, particularly in normal to mildly impaired GFR range. GFR(CKD-EPI) may improve risk stratification of individuals with MetS according to kidney function in community-based population. (C) 2013 Elsevier B.V. All rights reserved.