Obesity and insulin resistance as risk factors for chronic kidney disease.

The cardiometabolic syndrome is a state of metabolic and vascular dysregulation. The cardiometabolic syndrome is clinically composed of a cluster of metabolic abnormalities including insulin resistance/hyperinsulinemia, central/visceral obesity, dyslipidemia, hypertension, microalbuminuria, fibrinolytic and inflammatory abnormalities, endothelial dysfunction, oxidative stress, and hypercoagulability, which collectively lead to an increased risk of cardiovascular and renal outcomes. The development of microalbuminuria is now accepted as a marker of systemic endothelial dysfunction and, if it progresses to macroalbuminuria (i.e., >200 mg/d albuminuria), then kidney disease is evident. Collectively, visceral obesity, insulin resistance/hyperinsulinemia, and other components of the cardiometabolic syndrome lead to an increased risk of microalbuminuria and progressive loss of renal function. Hence, aggressive management of risk factors for the metabolic syndrome, nonpharmacologic and pharmacologic, is essential to prevent or delay the progressive loss of renal function and chronic kidney disease.