Kidney Week

Abstract: TH-PO0710

Biphasic Mortality Risk of Metabolic Syndrome in Patients Undergoing CKRT: A Nationwide Cohort Study

Session Information

• AKI: Prevention, Diagnostics, and Management
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Gu, Juyeon, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Juyeon Gu, MD

• Cho, Yoon Jung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoon Jung Cho, MD

• Jang, Yoonjoo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoonjoo Jang, MD

• Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Kyungho Lee, MD, PhD

• Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

Background

Continuous kidney replacement therapy (CKRT) is the predominant kidney replacement modality in critical care medicine. While the obesity paradox has been observed in CKRT patients, the relationship between metabolic syndrome and long-term outcomes remains incompletely understood. We investigated the association of metabolic syndrome and obesity with long-term outcomes in CKRT patients using National Health Insurance Service data.

Methods

Using the Korean National Health Insurance Service database, we identified all patients aged ≥20 years who initiated CKRT between 2010 and 2019 and underwent national health screening within 2 years before CKRT. Metabolic syndrome was defined according to the International Diabetes Federation criteria, and obesity was defined as a body mass index ≥25 kg/m^2. Cox regression models estimated the risk of all-cause mortality across three time periods: in-hospital, within 1 year after discharge, and beyond 1 year after discharge.

Results

Among 41,339 patients (mean age 66.2±12.2 years; 66% male), 24,426 (59.1%) had metabolic syndrome prior to CKRT. Metabolic syndrome was associated with lower in-hospital mortality (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.65–0.70) and lower mortality within 1 year after discharge (aHR 0.83, 95% CI 0.79–0.88). However, beyond 1 year after discharge, metabolic syndrome was associated with increased mortality risk (aHR 1.11, 95% CI 1.03–1.18). The concomitant presence of obesity with metabolic syndrome further reduced short-term mortality risk. Regular exercise modified the long-term association: patients with metabolic syndrome who exercised regularly did not have increased mortality beyond 1 year (aHR 0.94, 95% CI 0.81–1.09 vs. 1.14, 95% CI 1.06–1.22 for non-regular exercise; P for interaction = 0.024).

Conclusion

Metabolic syndrome exhibits biphasic mortality patterns in CKRT patients, with protective effects in the early post-discharge period transitioning to increased mortality risk in the long term. Regular physical activity may attenuate the adverse long-term effects of metabolic syndrome in CKRT survivors.