Kidney Week

Abstract: SA-PO0515

Metabolic-Dysfunction Associated CKD: Is It a Real Entity?

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Szeto, Cheuk-Chun, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong

Cheuk-Chun Szeto, MD

• Ng, Jack Kit-Chung, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong

Jack Kit-Chung Ng, MBChB

Background

Metabolic dysfunction–associated kidney disease (MDAKD) has been proposed to be a distinct CKD entity, potentially misclassified as hypertensive nephrosclerosis (HTN) or kidney disease of unknown causes.

Methods

We reviewed adult patients started on kidney replacement therapy (RRT) from 2010 to 2023. We examined the prevalence of metabolic dysfunction, represented by metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, Metabolic score for insulin resistance (METS-IR), and Metabolic score for visceral fat (METS-VF), across different kidney diagnosis categories, and their impact on estimated glomerular filtration rate (eGFR) decline. The pattern of biochemical features at eGFR 20 ml/min/1.73m², and arterial pulse wave velocity (PWV) at the initiation of RRT were also analyzed.

Results

We examined 1601 new RRT patients. There was no significant difference in the prevalence of metabolic syndrome between patients with HTN, unknown renal diagnosis, and other diagnosis groups, except that diabetic kidney disease (DKD) had higher rates. Metabolic syndrome was associated with a more rapid eGFR decline by -1.65 ± 0.07 ml/min/1.73m² per year (p <0.0001). Similarly, excessive visceral fat (defined as METS-VF ≥65) was associated with more rapid eGFR decline by -1.10 ± 0.09 ml/min/1.73m² per year (p <0.0001). Subgroup analysis showed that the effect of excessive visceral fat on the rate of eGFR decline was significant across all diagnosis groups. Hemoglobin, serum albumin, serum phosphate, albuminuria, and arterial PWV were all significantly different between diagnosis group, but none of the metabolic parameters had significant interaction with the diagnosis group.

Conclusion

Metabolic dysfunction is common in CKD, but it does not cluster in ways that make MDAKD a distinct diagnosis. Instead, metabolic dysfunction is a broad accelerator of CKD progression and vascular risk across all etiologic categories.