Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, CRS, Nigeria.
J Int Med Res. 2022 Apr;50(4):3000605221082874. doi: 10.1177/03000605221082874.
Body mass index (BMI), uric acid, diabetes mellitus, and hypertension are risk factors for reduced kidney function and are associated with fetuin-A levels, but their causal pathways remain unclear. The objective of this study was to investigate this knowledge gap.
A repeated cross-sectional design was used to assess causal pathway effects of fetuin-A on the estimated glomerular filtration rate (eGFR), which is mediated through BMI, uric acid, diabetes mellitus, and hypertension.
Among 2305 participants, the mean eGFR at baseline decreased from 98.7 ± 23.6 mL/minute/1.73 m in 2009 to 92.4 ± 22.9 mL/minute/1.73 m in 2014. Fetuin-A was significantly associated with eGFR , suggesting that increasing fetuin-A levels predict a decrease in eGFR. Additionally, the indirect effect of fetuin-A on eGFR, as assessed through BMI, was also significant. The effects of fetuin-A on eGFR through other mediation pathways showed variable results.
Our study revealed a possible role of fetuin-A in the etiology of declining renal function through mediating body mass index, uric acid, diabetes mellitus, and hypertension via complex causal pathways. Further studies to clarify these mediated effects are recommended.
体重指数（BMI）、尿酸、糖尿病和高血压是肾功能下降的危险因素，与胎球蛋白-A 水平相关，但它们的因果途径仍不清楚。本研究旨在探讨这一知识空白。
采用重复横断面设计评估胎球蛋白-A 对估计肾小球滤过率（eGFR）的因果途径效应，该效应通过 BMI、尿酸、糖尿病和高血压介导。
在 2305 名参与者中，基线时 eGFR 平均值从 2009 年的 98.7±23.6mL/minute/1.73m 下降至 2014 年的 92.4±22.9mL/minute/1.73m。胎球蛋白-A 与 eGFR 显著相关，表明胎球蛋白-A 水平升高预示着 eGFR 下降。此外，胎球蛋白-A 通过 BMI 对 eGFR 的间接效应也具有统计学意义。胎球蛋白-A 通过其他中介途径对 eGFR 的影响则显示出不同的结果。
本研究揭示了胎球蛋白-A 通过调节体重指数、尿酸、糖尿病和高血压，通过复杂的因果途径，在肾功能下降的发病机制中可能发挥作用。建议进一步研究以阐明这些中介效应。
