Renal disease, the metabolic syndrome, and cardiovascular disease.

OBJECTIVES: To describe the association between renal disease and other features of the metabolic syndrome and its derivative illnesses among Australian Aborigines in remote settings.
METHODS: Volunteering adults (N = 2019) in four remote communities were screened for risk factors and markers of renal disease, hypertension, and diabetes, and their cross-sectional associations were evaluated. Rates of the metabolic syndrome were estimated in one community with comprehensive screening data. The associations of albuminuria with hospitalizations, coronary heart events, and non-renal deaths were then followed for > 7 years in that same community.
RESULTS: Rates of renal disease, hypertension, and diabetes all increased dramatically with age. They all overlapped. Renal disease and hypertension were the most prominent and earliest features of the syndrome, while diabetes was a later, less common and more variable manifestation. All were strongly correlated with waist measurements, and high waist measurements more comprehensively characterized those with illnesses than did the more restrictive definitions of the metabolic syndrome. Albuminuria predicted non-renal hospitalizations, first time coronary heart disease events, and all-cause death.
CONCLUSION: Albuminuria/proteinuria is an early and dominant element of a symptom complex that is marked by higher waist measurements, and it strongly predicts all-cause and cardiovascular illnesses and deaths. This finding implies a common background of risk factors for renal disease, hypertension, diabetes, and cardiovascular risk. The findings support integrated, rather than disease-specific, surveillance programs, an important role for albuminuria in predicting non-renal risk, and a unified approach for primary and secondary prevention of all elements of the syndrome.