Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study
Introduction Limited research has focused on the prospective influence of insulin resistance (IR) on new-onset chronic kidney disease (CKD) in healthy screening populations. Therefore, we aimed to investigate how IR, assessed via the estimated glucose disposal rate (eGDR), and metabolism-related com...
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BMJ Publishing Group
2025-07-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/13/4/e005137.full |
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| author | Yang Zhang Xin Shen Guang Yang Ying Ding Jiahui Zhao Qingli Cheng Bokai Cheng Yansong Zheng |
| author_facet | Yang Zhang Xin Shen Guang Yang Ying Ding Jiahui Zhao Qingli Cheng Bokai Cheng Yansong Zheng |
| author_sort | Yang Zhang |
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| description | Introduction Limited research has focused on the prospective influence of insulin resistance (IR) on new-onset chronic kidney disease (CKD) in healthy screening populations. Therefore, we aimed to investigate how IR, assessed via the estimated glucose disposal rate (eGDR), and metabolism-related comorbidities influence new-onset CKD.Research design and methods This two-stage retrospective cohort study (cross-sectional and longitudinal analyses) used data from health check-up participants at the Chinese People’s Liberation Army General Hospital (2009–2021). The cross-sectional analysis included 83 346 participants with or without CKD; the longitudinal analyses included 13 738 participants without prior CKD who visited the hospital at least two times. The cross-sectional phase of this study analyzed the relationship between IR and CKD; the longitudinal phase analyzed the relationship between IR and new-onset CKD. The mediating role of metabolism-related comorbidities was also explored.Results In the cross-sectional analysis, 6.77% (n=5643) of patients had prior CKD. The eGDR was significantly higher in the non-CKD group than in the CKD group (9.16±2.11 vs 7.19±2.32, p<0.001). Higher eGDR was associated with lower CKD prevalence (OR: 0.91, 95% CI: 0.89 to 0.93, P for trend<0.001). In the cohort analysis, the average time to trigger endpoint events was 2.95±2.02 years, with 403 (2.93%) new-onset CKD cases reported. A linear correlation was observed between eGDR and new-onset CKD (p<0.001), with higher eGDR linked to reduced CKD risk (HR: 0.88, 95% CI: 0.82 to 0.96, P for trend=0.002). Mediation analysis revealed significant indirect effects of diabetes mellitus (17.1%), systolic blood pressure (22.0%), glycated hemoglobin (11.1%), and brachial–ankle pulse wave velocity (9.7%) (all p<0.05).Conclusions IR is independently linked to new-onset CKD, with blood glucose, blood pressure, and arterial stiffness mediating this relationship. These findings underscore the importance of managing IR and metabolic comorbidities to prevent CKD onset in at-risk populations. |
| format | Article |
| id | doaj-art-80caf0a2f376468e918fb8f22dfaeccc |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2025-07-01 |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-80caf0a2f376468e918fb8f22dfaeccc2025-08-20T03:08:52ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972025-07-0113410.1136/bmjdrc-2025-005137Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort studyYang Zhang0Xin Shen1Guang Yang2Ying Ding3Jiahui Zhao4Qingli Cheng5Bokai Cheng6Yansong Zheng7Department of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaDepartment of Geriatric Nephrology, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaHealth Management Institute, General Hospital of the People’s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, ChinaIntroduction Limited research has focused on the prospective influence of insulin resistance (IR) on new-onset chronic kidney disease (CKD) in healthy screening populations. Therefore, we aimed to investigate how IR, assessed via the estimated glucose disposal rate (eGDR), and metabolism-related comorbidities influence new-onset CKD.Research design and methods This two-stage retrospective cohort study (cross-sectional and longitudinal analyses) used data from health check-up participants at the Chinese People’s Liberation Army General Hospital (2009–2021). The cross-sectional analysis included 83 346 participants with or without CKD; the longitudinal analyses included 13 738 participants without prior CKD who visited the hospital at least two times. The cross-sectional phase of this study analyzed the relationship between IR and CKD; the longitudinal phase analyzed the relationship between IR and new-onset CKD. The mediating role of metabolism-related comorbidities was also explored.Results In the cross-sectional analysis, 6.77% (n=5643) of patients had prior CKD. The eGDR was significantly higher in the non-CKD group than in the CKD group (9.16±2.11 vs 7.19±2.32, p<0.001). Higher eGDR was associated with lower CKD prevalence (OR: 0.91, 95% CI: 0.89 to 0.93, P for trend<0.001). In the cohort analysis, the average time to trigger endpoint events was 2.95±2.02 years, with 403 (2.93%) new-onset CKD cases reported. A linear correlation was observed between eGDR and new-onset CKD (p<0.001), with higher eGDR linked to reduced CKD risk (HR: 0.88, 95% CI: 0.82 to 0.96, P for trend=0.002). Mediation analysis revealed significant indirect effects of diabetes mellitus (17.1%), systolic blood pressure (22.0%), glycated hemoglobin (11.1%), and brachial–ankle pulse wave velocity (9.7%) (all p<0.05).Conclusions IR is independently linked to new-onset CKD, with blood glucose, blood pressure, and arterial stiffness mediating this relationship. These findings underscore the importance of managing IR and metabolic comorbidities to prevent CKD onset in at-risk populations.https://drc.bmj.com/content/13/4/e005137.full |
| spellingShingle | Yang Zhang Xin Shen Guang Yang Ying Ding Jiahui Zhao Qingli Cheng Bokai Cheng Yansong Zheng Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study BMJ Open Diabetes Research & Care |
| title | Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study |
| title_full | Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study |
| title_fullStr | Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study |
| title_full_unstemmed | Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study |
| title_short | Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study |
| title_sort | influence of metabolism related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check up population a two stage retrospective cohort study |
| url | https://drc.bmj.com/content/13/4/e005137.full |
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