Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China.
Workers' Hospital of Jinchuan Group Co, Ltd, Jinchang, 737100, Gansu, China.
Endocrine. 2022 Aug;77(2):252-261. doi: 10.1007/s12020-022-03094-9. Epub 2022 Jul 2.
To evaluate the interaction effect of blood glucose and blood pressure on the risk of chronic kidney disease (CKD).
31,165 subjects were selected without CKD at baseline and had completed the first follow-up from "Jinchang cohort". Cox regression model and restricted cubic splines functions were used to evaluate the effects of blood glucose or pressure on the incidence of CKD and dose-response relationship after adjusting for confounding covariates. Synergic effect was assessed by the multiplicative or additive interaction scale.
Among 31,165 subjects, 1307 new-onset CKD were observed during 68905.78 person-years follow-up, and the incidence density was 18.97 per 1000 person-years. The risk of CKD gradually increased with the increase of blood pressure in diabetes, pre-diabetes and normal groups (P < 0.05). And, the risk was greatest when SBP/DBP reached ≥150/≥110 mmHg in three groups, and HRs (95% CI) were 1.610 (1.070-2.422), 2.142 (1.396-3.288) and 2.455 (1.941-3.106), respectively. Additionally, among hypertension, pre-hypertension and normal groups, the risk of CKD increased by 16.0%, 14.3% and 25.2% for each 1 mmol/L of FPG. When FPG level was more than 9.0 mmol/L, the risk was greatest and adjusted HRs (95% CI) were 2.856 (2.176-3.748), 2.979 (1.828-4.854) and 7.520 (4.517-12.519). Furthermore, the risk was highest when hypertension was accompanied by diabetes (HR = 4.915, 95% CI: 3.923-6.157). This analysis supported a less than multiplicative effect (HR = 0.634, 95% CI: 0.417-0.964) for the interaction term of diabetes and hypertension, while there was no additive interaction towards CKD in all interaction term.
Blood glucose and pressure were independent risk factors in incidence of CKD, but there was only a negative multiplicative interaction between hypertension and diabetes, but no additive interaction effect between them.
评估血糖和血压对慢性肾脏病（CKD）风险的交互作用。
本研究纳入了“金昌队列”中无 CKD 且完成首次随访的 31165 名受试者。采用 Cox 回归模型和限制立方样条函数，在调整混杂协变量后，评估血糖或血压对 CKD 发病的影响及其剂量-反应关系。采用乘法或加法交互作用尺度评估协同作用。
在 31165 名受试者中，在 68905.78 人年的随访期间观察到 1307 例新发 CKD，发病率密度为 18.97/1000 人年。在糖尿病、糖尿病前期和正常组中，随着血压的升高，CKD 的发病风险逐渐增加（P<0.05）。在三组中，当 SBP/DBP 达到≥150/≥110mmHg 时，风险最大，HR（95%CI）分别为 1.610（1.070-2.422）、2.142（1.396-3.288）和 2.455（1.941-3.106）。此外，在高血压、高血压前期和正常组中，FPG 每升高 1mmol/L，CKD 的发病风险分别增加 16.0%、14.3%和 25.2%。当 FPG 水平大于 9.0mmol/L 时，风险最大，调整后的 HR（95%CI）分别为 2.856（2.176-3.748）、2.979（1.828-4.854）和 7.520（4.517-12.519）。此外，当高血压合并糖尿病时，风险最高（HR=4.915，95%CI：3.923-6.157）。该分析支持糖尿病和高血压交互作用项的乘积效应较小（HR=0.634，95%CI：0.417-0.964），但在所有交互项中，两者对 CKD 无相加交互作用。
血糖和血压是 CKD 发病的独立危险因素，但高血压和糖尿病之间仅存在负性乘法交互作用，而无相加交互作用。
