Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
Department of Cardiovascular Medicine, Beijing Moslem Hospital, Beijing, 100054, China.
BMC Nephrol. 2018 Oct 25;19(1):294. doi: 10.1186/s12882-018-1098-8.
Recent studies have suggested that cardiometabolic index (CMI), a novel estimate of visceral adipose tissue, could be of use in the evaluation of cardiovascular risk factors. However, the potential utility and clinical significance of CMI in the detection of reduced estimated glomerular filtration rate (eGFR) remains uncertain. The purpose of this study was to investigate the usefulness of CMI in assessing reduced eGFR in the general Chinese population.
This cross-sectional analysis included 11,578 participants (mean age: 53.8 years, 53.7% females) from Northeast China Rural Cardiovascular Health Study (NCRCHS) of general Chinese population (data collected from January 2013 to August 2013). CMI was calculated by triglyceride to high density lipoprotein cholesterol ratio multiply waist-to-height ratio. Reduced eGFR was defined as eGFR< 60 ml/min per 1.73m. Multivariate regressions were performed to determine CMI's association with eGFR value and eGFR reduction, ROC analyses were employed to investigate CMI's discriminating ability for decreased eGFR.
The prevalence of reduced eGFR was 1.7% in males and 2.5% in females. CMI was notably more adverse in reduced eGFR groups, regardless of genders. In fully adjusted multivariate linear models, each 1 SD increment of CMI caused 3.150 ml/min per 1.73m and 2.411 ml/min per 1.73m loss of eGFR before CMI reached 1.210 and 1.520 in males and females, respectively. In logistic regression analyses, per 1 SD increase of CMI brought 51.6% additional risk of reduced eGFR in males while caused 1.347 times of risk in females. After divided into quartiles, people in the top quartile of CMI had higher adjusted ORs of having reduced eGFR, with ORs of 4.227 (1.681, 10.627) and 3.442 (1.685-7.031) for males and females respectively. AUC of CMI was revealed to be 0.633 (0.620-0.646) in males and 0.684 (0.672-0.695) in females.
Higher CMI was independently associated with greater burden of reduced eGFR, highlighting VAT distribution and dysfunction as a potential mechanism underlying the association of obesity with kidney damage and adverse cardiovascular outcomes. The findings from this study provided important insights regarding the potential usefulness and clinical relevance of CMI in the detection of reduced eGFR among general Chinese population.
最近的研究表明，心血管代谢指数（CMI）是一种新的内脏脂肪组织估计值，可用于评估心血管危险因素。然而，CMI 在检测估算肾小球滤过率（eGFR）降低方面的潜在效用和临床意义尚不确定。本研究旨在探讨 CMI 在评估中国普通人群中 eGFR 降低的作用。
本横断面分析纳入了来自中国东北农村心血管健康研究（NCRCHS）的 11578 名参与者（平均年龄：53.8 岁，53.7%为女性；数据收集于 2013 年 1 月至 2013 年 8 月）。CMI 通过甘油三酯与高密度脂蛋白胆固醇的比值乘以腰高比计算得出。eGFR<60ml/min/1.73m 定义为 eGFR 降低。采用多元回归分析确定 CMI 与 eGFR 值和 eGFR 降低的关系，ROC 分析用于研究 CMI 对降低的 eGFR 的鉴别能力。
男性 eGFR 降低的患病率为 1.7%，女性为 2.5%。无论性别如何，CMI 在 eGFR 降低组中均明显更为不利。在完全调整的多元线性模型中，CMI 每增加 1 个标准差，男性和女性的 eGFR 分别损失 3.150ml/min/1.73m 和 2.411ml/min/1.73m，直到 CMI 达到 1.210 和 1.520。在 logistic 回归分析中，CMI 每增加 1 个标准差，男性 eGFR 降低的风险增加 51.6%，女性的风险增加 1.347 倍。在四分位数分组中，CMI 处于最高四分位的人群，eGFR 降低的调整后比值比（OR）更高，男性为 4.227（1.681，10.627），女性为 3.442（1.685-7.031）。CMI 的 AUC 在男性中为 0.633（0.620-0.646），在女性中为 0.684（0.672-0.695）。
较高的 CMI 与更大的 eGFR 降低负担独立相关，提示 VAT 分布和功能障碍可能是肥胖与肾脏损害和不良心血管结局相关的潜在机制。本研究的结果为 CMI 在检测中国普通人群中 eGFR 降低方面的潜在效用和临床相关性提供了重要见解。
