Cardiometabolic-Renal Syndrome in CHARLS
Author(s):
Anita L R Saldanha, Ana Paula Marte Chacra, Ana Paula Pantoja Margeotto, André Luis Valera Gasparoto and Tania Leme da Rocha Martinez
Evidence from the China Health and Retirement Longitudinal Study (CHARLS) highlights the intertwined roles of kidney decline and cardiometabolic-renal syndrome in shaping health risks among middle-aged and older adults in China. Reduced kidney function, defined by an estimated glomerular filtration rate below 60 ml/min/1.73m2, is strongly associated with higher risks of cancer, hearing loss, and falls, emphasizing chronic kidney disease as a systemic driver of poor health rather than a condition limited to renal outcomes. CHARLS findings identify multiple risk factors for chronic kidney disease, including frailty, sarcopenia, circadian syndrome, social isolation, adverse early-life health and unfavorable social determinants, particularly in men. Conversely, regular physical activity of over 300 minutes per week consistently reduces chronic kidney disease risk by approximately 40%, underscoring its protective role. Cardiometabolic-renal syndrome, which integrates cardiovascular, metabolic, and renal dysfunction, is highly prevalent, with baseline rates ranging from 6.3% to 46.3% depending on classification. Disease progression is substantial, with nearly 30% worsening over four years. Chronic kidney disease incidence is particularly elevated in individuals with cardiovascular disease and metabolic syndrome. Determinants of cardiometabolic-renal progression include metabolic dysfunction, cardiovascular comorbidities, systemic inflammation (e.g., high C-reactive protein), visceral obesity, advanced age, male sex, and depression. Once again, physical activity emerges as a protective factor. Population disparities are evident: men tend to experience greater deterioration, lower socioeconomic groups face higher disability risks, and regional variations influence disease prevalence and staging. Overall, CHARLS studies reveal overlapping biological and social pathways linking kidney decline and cardiometabolic- renal syndrome, involving inflammation, frailty, and socioeconomic disadvantage. Physical activity consistently mitigates these risks, highlighting the importance of targeted interventions, particularly for older men, disadvantaged populations, and individuals with metabolic or cardiovascular vulnerabilities.