Clinical Characteristics and Efficacy of Individualized Treatment for IgA Nephropathy Combined with Metabolic Syndrome in Western Guangxi

Objective: To systematically analyze the epidemiological characteristics of metabolic syndrome in patients with IgA nephropathy in western Guangxi, and evaluate the efficacy of an individualized treatment regimen combining metabolic indicators and lifestyle interventions in protecting renal function. Methods: A retrospective cohort study was conducted. A total of 142 patients with primary IgAN confirmed by renal biopsy at Baise People’s Hospital between January 1, 2020 and December 31, 2025 were enrolled. Patients were stratified by MetS status and then divided into a conventional treatment group and an individualized treatment group according to actual treatment received, with 71 cases in each group. The conventional group received standard RAAS inhibitor plus glucocorticoid therapy. The individualized group additionally received targeted agents (SGLT2 inhibitors, atorvastatin calcium, bezafibrate, or amlodipine) based on metabolic abnormalities, plus structured lifestyle intervention. We reported the number and proportion of patients meeting the IDF MetS definition and compared baseline and outcome differences between patients with and without MetS. Primary outcomes included 1-year proteinuria remission rate, annual eGFR decline rate, and cardiovascular event rate. Propensity score analysis and multivariable adjustment, including metabolic variables, were performed to control confounding due to nonrandom treatment allocation. Multivariate Logistic regression identified independent prognostic factors, and an individualized decision-tree model was constructed. Results: Among 142 patients, 68 (47.9%) had MetS and 74 (52.1%) did not; MetS patients had higher baseline waist circumference, fasting glucose/HbA1c, triglycerides, lower HDL-C, heavier proteinuria, and lower eGFR (all P < 0.05). Baseline age, gender, eGFR, 24-h proteinuria, blood pressure, and BMI were comparable between groups (all P > 0.05). After propensity score matching, baseline metabolic parameters (waist circumference, fasting glucose/HbA1c, triglycerides, HDL-C) and the proportion meeting each MetS component were balanced (all P > 0.05). The 1-year complete proteinuria remission rate was 56.3% (40/71) in the individualized group vs. 35.2% (25/71) in the conventional group (P = 0.012). Annual eGFR decline was (2.8 ± 1.5) vs. (4.3 ± 2.1) mL/min/1.73 m²/year (P < 0.001). Cardiovascular event rates were 8.5% (6/71) vs. 18.3% (13/71) (P = 0.048). eGFR slope was estimated via linear mixed models using ≥ 3 serum creatinine