Abstract
Purpose
The roles of metabolic indices in predicting chronic kidney disease (CKD) were lacking. This study aimed to examine the concomitant impact of metabolic and novel anthropometric indices on incident CKD in the Chinese populations.
Methods
This prospective cohort study included 1825 males and 2218 females aged between 45 and 85 years, derived from the ongoing prospectively cohort of China Health and Retirement Longitudinal Study (CHARLS), from 2011 to 2015. The outcome was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2.
Results
During the 5-years follow-up period, 3.0% (55/1825) of males and 4.1% (90/2218) of the females developed CKD. After multivariable adjustment, elevated triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), serum uric acid (sUA), elevated visceral fat index (VFI), elevated body shape index (BSI) and elevated body roundness index (BRI) in males, and sUA, and BRI in females were the independent predictors for CKD. Composite scores, composed of sUA, history of cardiovascular disease (CVD), waist circumstance (WC), HDL-C, and BRI in males and sUA, hypertension, and BRI in females were constructed that could accurately predict CKD.
Conclusion
Our study found that elevated levels of TG, sUA, BSI, BRI, and diminished HDL in males and elevated levels of sUA, and BRI in females, are indicative of the incident CKD. The composite score, integrating a history of disease, metabolic indices, and noval anthropometric indices, could accurately differentiate individuals with and without incident CKD, proving useful for CKD care and management.
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Data Availability
The data underlying this article will be shared on reasonable request to the corresponding author.
References
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY, Yang CW (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382(9888):260–272. https://doi.org/10.1016/S0140-6736(13)60687-X
Huh JH, Yadav D, Kim JS, Son JW, Choi E, Kim SH, Shin C, Sung KC, Kim JY (2017) An association of metabolic syndrome and chronic kidney disease from a 10-year prospective cohort study. Metabolism 67:54–61. https://doi.org/10.1016/j.metabol.2016.11.003
Wang F, He K, Wang J et al (2018) Prevalence and risk factors for CKD: a comparison between the adult populations in China and the United States. Kidney Int Rep 3(5):1135–1143. https://doi.org/10.1016/j.ekir.2018.05.011
Li Y, Ning Y, Shen Bo, Shi Y, Song N, Fang Yi, Ding X, Temporal trends in prevalence and mortality for chronic kidney disease in China from, et al (1990) to 2019: an analysis for the Global Burden of Disease Study 2019. Clin kKdney J. https://doi.org/10.1093/ckj/sfac218
Oluwo O, Scialla JJ (2021) Uric Acid and CKD Progression Matures with Lessons for CKD Risk Factor Discovery. Clin J Am Soc Nephrol 16(3):476–478. https://doi.org/10.2215/CJN.10650620
Srivastava A, Kaze AD, McMullan CJ, Isakova T, Waikar SS (2018) Uric Acid and the Risks of Kidney Failure and Death in Individuals With CKD. Am J Kidney Dis 71(3):362–370. https://doi.org/10.1053/j.ajkd.2017.08.017
Wu N, Qin Y, Chen S, Yu C, Xu Y, Zhao J, Yang X, Li N, Pan XF (2021) Association between metabolic syndrome and incident chronic kidney disease among Chinese: A nation-wide cohort study and updated meta-analysis. Diabetes Metab Res Rev 37(7):e3437. https://doi.org/10.1002/dmrr.3437
Yan P, Xu Y, Miao Y, Tang Q, Wu Y, Bai X, Zhang Z, Li Q, Wan Q (2021) Association of lipid accumulation product with chronic kidney disease in Chinese community adults: a report from the REACTION study. Lipids Health Dis 20(1):131. https://doi.org/10.1186/s12944-021-01569-8
Huang J, Zhou C, Li Y, Zhu S, Liu A, Shao X, Liu X, Holthfer H, Zou H (2015) Visceral adiposity index, hypertriglyceridemic waist phenotype and chronic kidney disease in a southern Chinese population: a cross-sectional study. Int Urol Nephrol 47(8):1387–1396. https://doi.org/10.1007/s11255-015-1040-y
Dong Y, Wang Z, Chen Z, Wang X, Zhang L, Nie J, Zheng C, Wang J, Shao L, Tian Y, Gao R (2018) Comparison of visceral, body fat indices and anthropometric measures in relation to chronic kidney disease among Chinese adults from a large scale cross-sectional study. BMC Nephrol 19(1):40. https://doi.org/10.1186/s12882-018-0837-1
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G (2014) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 43(1):61–68. https://doi.org/10.1093/ije/dys203
Nishida C, Ko GT, Kumanyika S (2010) Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio. Eur J Clin Nutr 64(1):2–5. https://doi.org/10.1038/ejcn.2009.139
Liu LS. Writing Group of 2010 Chinese Guidelines for the Management of Hypertension. [2010 Chinese guidelines for the management of hypertension]. Zhonghua Xin Xue Guan Bing Za Zhi. 2011, 39(7):579–615.
Diabetes branch of Chinese Medical Association. Guidelines for the prevention and treatment of type 2 diabetes in China (2013 Edition). Chinese Journal of Endocrinology and metabolism 2014, 30(10): 893–942.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285(19): 2486–97. doi: https://doi.org/10.1001/jama.285.19.2486.
Krakauer NY, Krakauer JC (2012) A new body shape index predicts mortality hazard independently of body mass index. PLoS ONE 7(7):e39504. https://doi.org/10.1371/journal.pone.0039504
Thomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson CM, Ravussin E, Heymsfield SB (2013) Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring) 21(11):2264–2271. https://doi.org/10.1002/oby.20408
Adejumo EN, Adejumo AO, Azenabor A, Ekun AO, Enitan SS, Adebola OK, Ogundahunsi OA (2019) Anthropometric parameter that best predict metabolic syndrome in South west Nigeria. Diabetes Metab Syndr 13(1):48–54. https://doi.org/10.1016/j.dsx.2018.08.009
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, Levey AS; CKD-EPI Investigators. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 2012; 367(1): 20–9. doi: https://doi.org/10.1056/NEJMoa1114248.
Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158(11): 825–30. doi: https://doi.org/10.7326/0003-4819-158-11-201306040-00007.
Duan JW, Li YL, Li SX, Yang YP, Li F, Li Y, Wang J, Deng PZ, Wu JJ, Wang W, Meng CJ, Miao RJ, Chen ZH, Zou B, Yuan H, Cai JJ, Lu Y. Association of Long-term Ambient Fine Particulate Matter (PM2.5) and Incident CKD: A Prospective Cohort Study in China. Am J Kidney Dis 2022: S0272–6386(22)00623–0. doi: https://doi.org/10.1053/j.ajkd.2022.03.009.
Wu M, Shu Y, Wang L, Song L, Chen S, Liu Y, Bi J, Li D, Yang Y, Hu Y, Wang Y, Wu S, Tian Y (2022) Metabolic syndrome severity score and the progression of CKD. Eur J Clin Invest 52(1):e13646. https://doi.org/10.1111/eci.13646
Lin L, Tan W, Pan X, Tian E, Wu Z, Yang J (2022) Metabolic Syndrome-Related Kidney Injury: A Review and Update. Front Endocrinol (Lausanne) 13:904001. https://doi.org/10.3389/fendo.2022.904001
Wisse BE (2004) The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 15(11):2792–2800. https://doi.org/10.1097/01.ASN.0000141966.69934.21
Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ (2000) Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int 58(1):293–301. https://doi.org/10.1046/j.1523-1755.2000.00165.x
Yang S, Cao C, Deng T, Zhou Z (2020) Obesity-Related Glomerulopathy: A Latent Change in Obesity Requiring More Attention. Kidney Blood Press Res 45(4):510–522. https://doi.org/10.1159/000507784
Li L, Yang C, Zhao Y, Zeng X, Liu F, Fu P (2014) Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol 15:122. https://doi.org/10.1186/1471-2369-15-122
Li Y, He Y, Yang L, Liu Q, Li C, Wang Y, Yang P, Wang J, Chen Z, Huang X (2022) Body Roundness Index and Waist-Hip Ratio Result in Better Cardiovascular Disease Risk Stratification: Results From a Large Chinese Cross-Sectional Study. Front Nutr 9:801582. https://doi.org/10.3389/fnut.2022.801582
Chang Y, Guo X, Chen Y, Guo L, Li Z, Yu S, Yang H, Sun Y (2015) A body shape index and body roundness index: two new body indices to identify diabetes mellitus among rural populations in northeast China. BMC Public Health 15:794. https://doi.org/10.1186/s12889-015-2150-2
Kawarazaki W, Fujita T (2021) Kidney and epigenetic mechanisms of salt-sensitive hypertension. Nat Rev Nephrol 17(5):350–363. https://doi.org/10.1038/s41581-021-00399-2
Cho KH, Kang DJ, Nam HS, Kim JH, Kim SY, Lee JO, Kim BJ (2021) Ozonated sunflower oil exerted protective effect for embryo and cell survival via potent reduction power and antioxidant activity in hdl with strong antimicrobial activity. Antioxidants (Basel) 10(11):1651. https://doi.org/10.3390/antiox10111651
Chen JS, Wang MX, Wang MM, Zhang YK, Guo X, Chen YY, Zhang MQ, Sun JY, Liu YF, Liu C (2022) Synthesis and biological evaluation of geniposide derivatives as inhibitors of hyperuricemia, inflammatory and fibrosis. Eur J Med Chem 237:114379. https://doi.org/10.1016/j.ejmech.2022.114379
Wang F, He K, Wang J, Zhao MH, Li Y, Zhang L, Saran R, Bragg-Gresham JL (2018) Prevalence and Risk Factors for CKD: A Comparison Between the Adult Populations in China and the United States. Kidney Int Rep 3(5):1135–1143. https://doi.org/10.1016/j.ekir.2018.05.011
Yang C, Wang H, Zhao X, Matsushita K, Coresh J, Zhang L, Zhao MH (2020) CKD in China: Evolving Spectrum and Public Health Implications. Am J Kidney Dis 76(2):258–264. https://doi.org/10.1053/j.ajkd.2019.05.032. (Epub 2019 Sep 3)
Acknowledgements
The authors thank the CHARLS team for their hard work and unselfish sharing of survey data.
Funding
Apart from the original grants to the CHARLS, this study was sponsored by the Natural Science Foundation of Shanghai (21ZR1412400), Shanghai Key Laboratory of Kidney and Blood Purification (14DZ2260200), Shanghai Science and Technology Commission (18411960800), Shanghai Municipal Key Clinical Specialty (shslczdzk02501), Shanghai Three-year Action Plan to Strengthen the Public Health System (GWVI-11.2-YQ10), and Youth Fund of Zhongshan Hospital (2022ZSQN10).
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BZ and YL contributed to the conception or design of the work. YS, NS, SZ and BS contributed to the acquisition, analysis, or interpretation of data for the work. BZ and YL drafted the manuscript. XD and YL critically revised the manuscript. YF, JW, and WZ contribute to analysis, or interpretation of the work. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.
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Zhu, B., Shi, Y., Song, N. et al. Associations between metabolic profiles and incident CKD in the Chinese population aged 45–85 years. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-023-03916-3
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DOI: https://doi.org/10.1007/s11255-023-03916-3