The Cardio-Metabolic Risk Factors And Cardiovascular Outcomes Of Chronic Kidney Disease The Cardio-Metabolic Risk Factors And Cardiovascular Outcomes Of Chronic Kidney Disease

BackgroundWith the development of social economy,rapid change of lifestyles,and inevitable trend of urbanization,the incidence of cardiovascular disease and metabolic disorders increased,and chronic kidney disease(CKD)also spread rapidly.The latest data showed that diabetic nephropathy was the leading cause of CKD in China,making the society bear a substantial burden of health care costs.Therefore,it is of great significance to identify cardio-metabolic risk factors and investigate the effects of initial renal damage on cardiovascular outcomes to take positive and effective measures to prevent CKD and maintain human health.Study design and methods1.The relationship between cardio-metabolic risk factors and CKD: Using cluster sampling,we performed our study among participants from Risk Evaluation c Ancers in Chinese diabetic Individuals: a l ONgitudinal(REACTION)study at baseline(n=250752)and during follow-up(n=59777),Shanghai Baoshan community-based cohort study at baseline(n=3933)and during follow-up(n=2491),and Shanghai Jiading community-based cohort study during follow-up(n=5845).Questionnaire was used to collect information on lifestyle factors and history of chronic diseases.Anthropometric measurements included weight,height,and blood pressure.Oral glucose tolerance test(OGTT)was performed in each individual,and blood and urine samples were collected to take biochemical measurements.Estimated glomerular filtration rate(eGFR)was calculated according to Chronic Kidney Disease-Epidemiology Collaboration(CKD-EPI)equation.CKD was defined as eGFR < 60 ml/min per 1.73 m2 or urinary albumin-to-creatinine ratio ≥ 30 mg/g.2.Effects on cardiovascular outcomes of CKD: Using cluster sampling,we performed our study among participants from community-based cohort study in Jiading district,Shanghai at baseline(n=9136)and REACTION study at baseline(n=239832).Questionnaire interview,anthropometric measurements,and OGTT were performed in each individual,and blood and urine samples were collected to take biochemical measurements.Estimated glomerular filtration rate(eGFR)was calculated according to CKD-EPI equation.In the community of Jiading district,brachial-ankle pulse wave velocity(baPWV)value was determined by Colin VP-1000.In REACTION study,the Framingham Risk Score(FRS)and estimated 10-year ASCVD risk score were calculated.RHF was defined with the highest age–specific quartile of eGFR.Results1.In the community-based middle-aged and elderly Chinese,the prevalence and incidence rate of CKD gradually increased with the deterioration of glucose metabolism status in both men and women.Among men,compared to participants with normal glucose regulation,those with prediabetes,newly-diagnosed diabetes,and previously-diagnosed diabetes had an increased risk of prevalent CKD,and had 10%(adjusted odds ratio(OR)=1.10,95% confidence interval(CI)1.00-1.34),17%(adjusted OR=1.17,95% CI 1.03-1.39),and 74%(adjusted OR=1.74,95% CI 1.33-2.28)increased risk of incident CKD,while among women,there was no relationship between prediabetes and CKD;in the analysis of the association between obesity and CKD,participants with obesity had increased risk of prevalent CKD than those with normal weight,and there was no relationship between obesity and CKD among those without diabetes,hypertension,or hyperlipidemia.Multivariate logistic regression analysis showed that compared with metabolically healthy nonobesity,metabolically healthy obesity(MHO)was associated with incident CKD(adjusted OR=1.65,95% CI 1.01-2.69),and metabolically unhealthy nonobesity and metabolically unhealthy obesity were significantly associated with CKD.Mediation analysis showed that high-sensitivity C-reactive protein might mediate the association between obesity phenotype and CKD(indirect effect=0.006,95% CI 0.003-0.009,P < 0.0001);In the analysis of the association between cardiovascular health(CVH)and CKD,multivariate logistic regression analysis showed a reduced risk of CKD with increasing number of ideal CVH components.The OR for incident CKD in participants with 5 to 6 ideal CVH components was 0.35(95% CI 0.20-0.61),and population-attributable fraction was 53.0(95% CI 22.0-71.7).2.In the middle-aged and elderly Chinese without CKD,each 10 ml/min per 1.73 m2 increment of eGFR conferred 17% and 28% higher risk of having elevated baPWV and elevated PP,respectively.The propensity score matching analysis showed that RHF was associated with increased risk of elevated baPWV and PP(elevated baPWV: OR 1.17,95% CI 1.03–1.30;elevated PP: OR 1.28,95% CI 1.13–1.46);In the general middle-aged and elderly Chinese adults,multivariate logistic regression analysis showed that CKD,and even mildly reduced renal function(eGFR 60-89 ml/min per 1.73 m2)was associated with 10-year high risk of ASCVD.Among men,the ORs for CKD in participants with eGFR 75-89 and eGFR 60-74 ml/min per 1.73 m2 were 1.57(95% CI 1.44-1.73)and 1.60(95% CI 1.35-1.90),respectively,and among women,the ORs were 1.25(95% CI 1.17-1.33)and 1.30(95% CI 1.16-1.45),respectively.ConclusionsIn the middle-aged and elderly Chinese adults,participants with prediabetes,newlydiagnosed diabetes and previously-diagnosed diabetes had an increased risk of incident CKD.In addition,MHO was not a harmless condition.MHO was significantly associated with incident CKD,and the level of systemic inflammation partially explained this association.Moreover,ideal CVH condition was associated with a decreased risk of incident CKD.We also demonstrated that participants with RHF had an increased risk of arterial stiffness,and even mildly reduced renal function was associated with 10-year high risk of ASCVD.