Ciardullo S, Ballabeni C, Trevisan R, et al. - This large cross-sectional study reveals that metabolic syndrome (MS) rather than obesity is linked to kidney damage and that the obese participants without MS (OB+ MS−) phenotype does not appear to be related to an elevated risk of kidney disease.

• All adult individuals (n = 12,335) with available data on BMI, estimated glomerular filtration rate (eGFR), urine albumin to creatinine ratio (UACR), and each MS component were included in the study.

• OB+ MS− were younger and more often female.

• After adjustment for potential confounders, compared with OB− MS− participants, both OB− MS+ groups and the OB+ MS+ groups had a greater prevalence of albuminuria and a lower eGFR, but not the OB+ MS− groups.

• When each of the MS components was examined separately, raised blood pressure and low high-density lipoprotein cholesterol were correlated with both UACR and lower eGFR, whereas elevated blood glucose and triglycerides were related to only UACR.

• Waist circumference was not related to any of the renal outcomes studied.