The Relationship Between Rectus Femoris Cross-sectional Area Combine With Visceral Fat Area And The Progression Of Diabetic Kidney Disease

ObjectiveTo explore the correlation between rectus femoris cross-sectional area(RFCSA)and visceral fat area(VFA)on the progression of diabetic kidney disease(DKD),so as to provide new ideas and strategies for early prevention and treatment of DKD.MethodsThis cross-sectional study included 879 type 2 diabetes mellitus(T2DM)adult patients hospitalized in the Department of Endocrinology,Shenzhen Hospital,Southern Medical University from March 1 st,2020 to December 31 st,2021.VFA was assessed by bioimpedance analysis(BIA)method and RFCSA was measured by ultrasound Biochemical indicators such as serum creatinine(SCr),serum cystatin C(SCysC),24-hour urinary albumin excretion rate(24h UAER)and urinary albumin-to-creatinine ratio(UACR)and other factors were measured.And estimate glomerular filtration rate(eGFR)was calculated based on CKD-EPI SCR-SCysC Joint Formula.Then participants were divided into four groups according to different levels of urinary protein and eGFR as follows:low-risk group,moderately-increased-risk group,highrisk group and very-high-risk group for progression of DKD.The basic data of the four groups were analyzed by analysis of variance,Kruskal-Wallis rank sum test and chi-square test.And after all data grouped by sex,Spearman correlation analysis and multivariate Logistic regression analysis were used to explore the risk factors of DKD progression and the role of RFCSA and VFA in progression of DKD.And receiver-operating characteristic(ROC)curve was used to explore the predictive value of diabetes duration combined with RFCSA and VFA for high-risk group of DKD.ResultsAfter comparing the four groups of DKD,there were significant differences in age,diabetes duration,blood pressure,fasting C-peptide,SCr,SCysC,uric acid,triglyceride,urea nitrogen,24h UAER and UACR among the four groups(P<0.001).Spearman’s correlation analysis found that the deterioration of DKD was positively correlated with diabetes duration,triglyceride and VFA(P<0.05),but negatively correlated with RFCSA(P<0.05)in both male and female patients.Multivariate Logistic regression showed that the decrease of RFCSA,the increase of diabetes duration and VFA were the risk factors for the progression of DKD.ROC curve analysis was used to further explore the predictive value of RFCSA,VFA and diabetes duration in high-risk group of DKD.The results showed that for male patients,the area under the curve was 0.82(95%CI:0.78～0.88,P<0.001),the optimal cut-off value:diabetes duration was 7 years,RFCSA was 6.6 cm2,VFA was 111 cm2(sensitivity 78.0%,specificity 68.6%);for female patients,the area under the curve was 0.73(95%CI:0.66～0.81,P<0.001),the optimal cut-off value:diabetes duration was 9 years,RFCSA was 5.05 cm2,VFA was 91 cm2(sensitivity 73.9%,specificity 63.3%).Conclusions1.The increased VFA and the decreased RFCSA can be used as markers in the progression of DKD.2.When the diabetes duration>7 years combined with RFCSA<6.6 cm2 and VFA>111 cm2,male patients with T2DM are more likely to develop high-risk DKD;when the diabetes duration>9 years combined with RFCSA<5.05 cm2 and VFA>91 cm2,female patients with T2DM are more likely to develop high-risk DKD.