Original Article Effect of metabolic syndrome on clinical outcomes of non-diabetic peritoneal dialysis patients in India NARAYAN PRASAD, 1 ARCHANA SINHA, 2 AMIT GUPTA, 1 RAJ K SHARMA, 1 ANUPAMA KAUL, 1 DHARMENDER BHADAURIA 1 and DHARSHAN RANAGSWAMY 1 Departments of 1 Nephrology and 2 Dietetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India KEY WORDS: metabolic syndrome, non-diabetic patient, peritoneal dialysis. Correspondence: Dr Narayan Prasad, Department of Nephrology, Sanjay Gandhi Postgraduate, Institute of Medical Sciences, Lucknow 226014, India. Email: narayan.nephro@gmail.com; narayan@sgpgi.ac.in Accepted for publication 30 June 2013. Accepted manuscript online 8 July 2013. doi:10.1111/nep.12124 SUMMARY AT A GLANCE This manuscript documents that the incidence of the metabolic syndrome in non-diabetic Indian PD patients (n = 163) was high at 51.5% and was a predictor of patient survival, and PD technique survival. ABSTRACT: Aim: Metabolic syndrome (MS) is associated with higher mortality and morbidity in the general population. However, the effect of MS and its individual components on clinical outcomes in non-diabetic peritoneal dialysis (PD) patients has not been widely studied in India. Our aim was to study the prevalence of MS in non-diabetic PD patients who were on PD for at least 3 months and to analyze the influence of MS and its individual components on clinical outcomes of these patients on subsequent follow up. Methods: We prospectively included 163 non-diabetic PD patients (mean age 45.1 ± 16.2 years, 104 male). MS was defined using the modified National Cholesterol Education Programme (ATP III) criteria. Outcomes of patients with and without MS were compared. Results: Of the 163 non-diabetic PD patients, 84 (51.5%) patients had MS. The mean follow up duration was 24.0 ± 14.0 patient months. Patients with MS had significantly greater body mass index (P = 0.007), Systolic BP (P = 0.001), diastolic BP (P = 0.001), Triglycerides (P = 0.002), total cholesterol (P = 0.001) level; and significantly lower high density lipoprotein (P = 0.013) values. Mean survival (patient-months) of patients with MS (30.7 (95%CI 27.1–34.3)) was significantly inferior to that of patients without MS (55.6 (95% CI 50.8–60.4), P = 0.001). Mean technique survival of patients with MS was also significantly lower (38.9 (95% CI 35.9–41.9)) compared to that of patients without MS (61.5 (95% CI 58.3–64.7), P = 0.039). On univariate Cox regression analysis diastolic BP (P = 0.003), Systolic BP (P = 0.026), hyperten- sion (HTN) (P = 0.001) and MS (P = 0.001) were found to be independent predictors of mortality. However on multivariate Cox hazard regression analysis, only MS (HR 5.39 (95% CI 2.06–14.14), P = 0.001) was found to be the significant predictors of mortality in these patients. Among the factors other than components of MS, the presence of comorbidities (P = 0.029), serum albumin (P = 0.042), non-HDL cholesterol (P = 0.003), total cholesterol/HDL (P = 0.001) and MS (P = 0.001) were important factors predicting mortality on univariate Cox regression, while only MS (P = 0.001) and serum albumin (P = 0.013) were the independent factors predicting mortality on multivari- ate analysis. Conclusion: Prevalence of MS in non-diabetic PD patient is high and predicts long term patient and technique survival. Metabolic syndrome (MS) is constellation of metabolic factors that are associated with a twofold risk of cardiovas- cular disease (CVD) and a fivefold risk of new onset diabetes within 5 years, with an even higher long-term risk. 1 Approximately 15–25% of the world’s general popula- tion have features of MS, 2 and persons with MS have high probability of developing morbidities and mortality depend- ing on the number of components present. 3 MS is also an independent risk factor for developing chronic kidney disease (CKD) in the general population; 4,5 and patients with Nephrology 18 (2013) 657–664 © 2013 The Authors Nephrology © 2013 Asian Pacific Society of Nephrology 657