The metabolic syndrome (MS) and chronic kidney disease (CKD) have both become global public health problems, with increasing social and economic impact due to their high prevalence and remarkable impact on morbidity and mortality. The causality between MS and CKD, and its clinical implications, still does remain not completely understood. Moreover, prophylactic and therapeutic interventions do need to be properly investigated in this field. Herein, we critically review the existing clinical evidence that associates MS with renal disease and cardiovascular disease, as well as the associated pathophysiologic mechanisms and actual treatment options. 1. Introduction During the last decades, we have witnessed a global epidemic of obesity [1]. A sedentary lifestyle and an atherogenic diet, along with genetic predisposition, are probably the driving forces of this problem. According to the last National Health and Nutrition Examination Survey (NHANES), more than one third of adult Americans are obese. The prevalence in children and adolescents is also rising at an alarmingly rate [2]. Obesity, particularly abdominal obesity, is associated with resistance to the effects of insulin on peripheral glucose and fatty acid utilization. The resulting hiperinsulinemia and hyperglycemia, as the release of adipocyte cytokines, have been shown to induce vascular endothelial dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which are atherogenic [3–6]. The clustering of metabolic cardiovascular risk factors, under a common pathogenic process (insulin resistance), was described for the first time in 1988 by Reaven [3], leading to the concept of Metabolic Syndrome (MS). Since then, multiple definitions have been made, all of them considering some combination of insulin resistance, dyslipidemia (hypertriglyceridemia, low HDL cholesterol), elevated fasting serum glucose, abdominal obesity, and hypertension (Table 1) [7–11]. Table 1: Current definitions of the metabolic syndrome. The MS affects over 20% of adults in Western populations [12], and is becoming increasingly common [13–15], inclusively in adolescents [16]. However, the prevalence of MS varies widely according to geographic location, race, gender, and urbanization. Since it was first described, an overwhelming body of evidence associated the MS with subsequent development of type II diabetes mellitus and cardiovascular disease (CVD) [17–25]. Recently, the evidence associating MS with CVD has been synthesized in three meta-analyses that showed an increased risk for incident CVD
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