Epidemiological Investigation Of CKD And The Correlation With CVAI,LAP Among Elderly People In Rural Areas Of Yangzhou City

PurposeThis study aims to investigate the prevalence of chronic kidney disease(CKD)in rural residents aged 65 years and above in Yangzhou,explore the risk factors associated with CKD in the local elderly,further analyse the correlation between the Chinese Visceral Obesity Index(CVAI),lipid accumulation products(LAP)and CKD in the elderly.This provides guidance for the early management of chronic kidney disease in the rural elderly in Yangzhou.MethodsThis study is a cross-sectional survey of 5,405 randomly selected elderly people aged 65 years and above who voluntarily participated in health check-ups in the district of Subei People’s Hospital-Da Yi Town Health Centre Medical Cluster from January to December 2021.General data(age,gender),past medical history(hypertension,diabetes,hyperlipidemia),physical examination data(height,weight,waist circumference,blood pressure)and laboratory examination data are collected from the study subjects.The five measures of obesity are Waist circumference(WC),Body mass index(BMI),Waist-to-height ratio(WHtR),CVAI and LAP.The measurement data is expressed as(±s),and the t-test or Mann-Whitney U-test is used for comparison between groups,the enumeration data is expressed as[n(%)],and the chi-square test is used for comparison between groups.Logistic regression is used to analyze the risk factors associated with CKD and the correlation among CVAI,LAP and CKD,and the receiver operating characteristic curve(ROC)of the subject is further plotted,and the area under the curve(AUC)is compared to evaluate the predictive effect of various human obesity measurement indicators on CKD.Results1.Basic characteristics of the subject:(1)A total of 5,405 elderly people aged≥65 years are included in this study,with an age range of 65 to 96 years old and a mean age of 72.81±5.36.The male to female ratio is approximately 1:1.The proportion of elderly people aged between 65 and 75 years(excluding 75)is 70.9%;the proportion of elderly people aged between 75 and 85 years(excluding 85)is 25.5%,and the proportion of elderly people aged 85 years and above is 3.6%.There is no significant difference in the age distribution between men and women(P>0.05).(2)Among the 5405 study participants,the prevalence of hypertension,diabetes mellitus,hyperlipidemia,obesity,abdominal obesity and anemia are 61.0%,21.6%,30.3%,14.0%,37.4%,and 7.4%.The prevalence of blood pressure,diabetes mellitus,hyperlipidemia,obesity and abdominal obesity in the female group is higher than that in men,while the prevalence of anemia is significantly lower than that in men(P<0.05).(3)In the study population,BMI,WHtR,CVAI and LAP are significantly lower in men than that in women,while WC indicators are higher than that in women(P<0.05).2.Prevalence of CKD in the study population:(1)Among the 5405 elderly people,605 patients with CKD are detected,with an overall prevalence of 11.2%.Among them,270(44.6%)male CKD patients are detected,while 335(55.4%)female CKD patients are detected.Estimated glomerular filtration rate(eGFR)decreased in 487 patients with a prevalence rate of 9.0%,and proteinuria are detected in 173 patients with a prevalence rate of 3.2%.Based on the eGFR,CKD patients are divided into 5 stages,of which 75 patients(12.4%)are detected in stage G2,477 patients(78.8%)are detected in stage G3,36 patients(6.0%)are detected in stage G4 and 17 patients(2.8%)are detected in stage G1/G5.(2)The prevalence of CKD and eGFR decline is significantly higher in the female group than that in the male group(P<0.05),while the difference in the prevalence of proteinuria has no gender diferrences statistically(P>0.05).The prevalence of CKD,decreases eGFR and proteinuria increases with age(P<0.05).(3)The detection rates of chronic diseases such as hypertension,diabetes mellitus,hyperlipidemia,obesity,abdominal obesity and anemia are significantly higher in the CKD group than that in the non-CKD group(P<0.05).The levels of age,SBP,FPG,TG and BUN are significantly higher in the CKD group than that in the non-CKD group(P<0.05),while the levels of HB and HDL-C are significantly lower than that in the non-CKD group(P<0.05).(4)The results of multivariate logistic regression analysis show that advanced age,obesity,hypertension,diabetes mellitus and hyperlipidemia are independent risk factors for CKD among the elderly in rural areas of Yangzhou City(P<0.05).3.Correlation analysis of CVAI,LAP and CKD in the elderly:(1)WC,BMI,WHtR,CVAI and LAP are higher in the CKD group than that in the non-CKD group in both men and women,and the differences are statistically significant(P<0.05).(2)According to the quartile of CVAI and LAP in men and women,CVAI and LAP are divided into Cl-C4 and L1-L4 groups from low to high.The number of elderly patients with CKD,decreased eGFR and proteinuria increases with increasing CVAI and LAP quartile levels,regardless of gender.(3)Based on the quartile level grouping of CVAI and LAP,the odds ratio(OR)value of the risk of CKD in the elderly showed an increasing trend with the increase of the quartile level of CVAI and LAP in the unadjusted model.After adjusting for possible confounders such as age and various comorbidities(hypertension,diabetes,hyperlipidemia,anemia,obesity,abdominal obesity),the risk of CKD is 1.954 and 4.153 times higher in male in C3 and C4 groups than that in C1 group,respectively(P<0.05),and 1.775,2.981,and 4.260 times higher in male in L2,L3,and L4 groups than that in L1 group,respectively(P<0.05).The risk of CKD is 1.775,2.981 and 4.260 times higher in male in L2,L3 and L4 groups than that in L1 group,respectively(P<0.05).The risk of CKD is 2.580,3.369 and 5.976 times higher in women in C2,C3 and C4 groups than that in C1 group,respectively(P<0.05),and 1.579,3.286 and 3.528 times higher in women in L2,L3 and L4 groups than that in L1 group(P<0.05).(4)The ROC curves of CKD patients are predicted based on human obesity measures such as WC,BMI,WHtR,CVAI,and LAP.The results shows that all anthropometric obesity measures have certain predictive value for the risk of CKD in the elderly(P<0.05).CVAI and LAP are superior to WC,BMI,and WHtR in predicting CKD in the elderly.The AUC of male CVAI and LAP are 0.651(95%CI:0.6160.685)and 0.624(95%CI:0.590-0.657),respectively.The AUC of female CVAI and LAP are 0.654(95%CI:0.624-0.685)and 0.608(95%CI:0.576-0.639),respectively.Conclusion1.The prevalence of CKD among the elderly in rural areas of Yangzhou City is 11.2%,which is similar to the results of the overall adult CKD prevalence survey in China in 2012.2.Advanced age,obesity,hypertension,diabetes mellitus and hyperlipidemia are independent risk factors for CKD among the elderly in rural areas of Yangzhou City,3.CVAI and LAP are positively correlated with the risk of CKD in rural elderly people in Yangzhou City,and they are superior to traditional human obesity measures such as WC,BMI,and WHtR in predicting CKD.CVAI and LAP can be used as simple,economical,and effective tools for early identification of high-risk patients with CKD.