Glucose metabolism indices and the development of chronic kidney
disease: a cohort study of middle-aged and elderly Chinese persons
Abstract
Background Chronic kidney disease (CKD) has become a major global health
issue, and abnormalities of glucose metabolism are a risk factor
responsible for development of CKD. We aimed to investigate associations
between glucose metabolism indices and CKD in a Chinese population, and
determine which index is superior for predicting incident CKD. Methods
This community-based population study included 5232 subjects aged ≥40
years without baseline CKD. CKD was defined as an estimated glomerular
filtration rate (eGFR) <60 mL/min/1.73 m2 or urinary
albumin-to-creatinine ration (UACR) ≥30 mg/g. We examined the
associations of glucose metabolism indices, including fasting plasma
glucose (FPG), 2-hour (2h) oral glucose tolerance test (OGTT),
haemoglobin A1c (HbA1c), fasting insulin level, homeostasis model
assessment of insulin resistance (HOMA-IR), and HOMA-β and the
development of CKD. Results With an average follow-up of 3.6 years,
6.4% of the subjects developed CKD. Pearson’s correlation analysis
revealed that FPG, HbA1c, fasting insulin, and HOMA-IR were all
significantly correlated with UACR and eGFR. The association persisted
in multivariate linear regression analysis adjusted for age and sex.
Compared with other glucose indices, HOMA-IR exhibited the strongest
associations with CKD in COX multivariate regression analysis (HR =
1.17, 95% CI: 1.04-1.31). Conclusion HOMA-IR is superior to other
routine indices of glucose metabolism for predicting the development of
CKD in middle-aged Chinese persons. Screening with HOMA-IR may help
prevent the development of CKD in the general population.