A RECENT study has illustrated the prognostic role of the metabolic profile for predicting renal and cardiovascular endpoints in patients with IgA nephropathy (IgAN). The results from this research, led by Balázs Sági, University of Pécs, Hungary, pointed specifically to the predictive value of body mass index (BMI), hyperuricemia, hypertension, and diabetes for determining the prognosis of IgAN, suggesting the importance of early risk stratification based on patients’ metabolic profiles.
To investigate the effects of metabolic syndrome and metabolic profiles on the renal and cardiovascular outcomes of IgAN, investigators prospectively assessed patients ≥18 years of age with confirmed IgAN who were not currently or previously on immunosuppressive treatment or had severe comorbidities. Metabolic syndrome was defined based on the National Cholesterol Education Program Adult Treatment Panel III criterion, which includes any three of the following: waist circumference (>102 cm in males, >90 cm in females) or BMI >27 kg/m2, fasting glucose ≥5.6 mmol/L, triglyceride ≥1.7 mmol/L, HDL cholesterol <1.0 mmol/L in males and <1.3 in females, and systolic/diastolic blood pressure >130/85 mmHg. In total, data from 125 patients was included (average age = 53.0 ± 12.7 years; 74% male). Of these patients, 52% had metabolic syndrome.
Kaplan–Meier curves showed significantly worse survival in cases of hypertension (primary endpoint: P = 0.004, secondary renal endpoint: P = 0.020; secondary CV endpoint: P = 0.0038), diabetes mellitus (P = 0.002, P = 0.008, P = 0.007), and a higher BMI (cut-off 25 kg/m2) (P = 0.028, P = 0.015, P = NS) in both primary and secondary endpoints. The team highlighted that there was a non-significant difference in the primary and secondary outcomes in the case of dyslipidaemia, but investigators found significant differences in the case of hyperuricemia.
Upon comparison of patients with IgAN with and without metabolic syndrome, the team observed significant differences in survival on the Kaplan-Meier curves in the case of the primary combined endpoint (P <0.001) and the secondary renal (P = 0.001) and cardiovascular endpoints (P = 0.001).
The researchers commented that this study “proved that despite the lower number of cases, but longer prospective follow-up, the importance of metabolic changes at the start of IgAN have an important impact on the outcome,” emphasising the need for risk stratification of IgAN patients in identifying high-risk individuals.
Victoria Antoniou, EMJ
Reference
Sági B et al. Does metabolic syndrome and its components have prognostic significance for renal and cardiovascular outcomes in IgA nephropathy? Biomedicines. 2024;12(6):1250.
