Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445 Taiwan.
School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445 Taiwan.
Int J Med Sci. 2022 Sep 21;19(11):1660-1671. doi: 10.7150/ijms.75824. eCollection 2022.
Obesity and cognitive function decline are independent risk factors for chronic kidney disease (CKD). However, few studies have examined the combined effects of obesity status and cognitive function on change in CKD risk. We aimed to evaluate the association between obesity status, cognitive function and CKD risk change in patients with type 2 diabetes mellitus (T2DM). Data on 3399 T2DM patients were extracted from a diabetes disease management program between 2006 and 2018. Univariate and multivariate analyses were used to assess the association between obesity, cognitive decline, and CKD risk change. Three indexes, including the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI), were used to analyze interactions. CKD risk was classified according to the KDIGO 2012 CKD definition. In multivariate analysis, the hazard ratio (HR, 95%Cis) for CKD risk progression was 1.34 (1.12-1.61) times higher in the moderate and severely obese patients compared with the normal weight patients, and 1.34 (1.06-1.67) times higher in the patients with a Mini-Mental State Examination (MMSE) score ≤18 compared to those with an MMSE score ≥24. There was a synergistic interaction between moderate and severe obesity and MMSE score ≤18 on CKD risk progression (SI=4.461; 95% CI: 1.998-9.962), and the proportion of CKD risk progression caused by this interaction was 52.7% (API=0.527; 95% CI: 0.295-0.759). However, normal weight and MMSE score ≥24 were not beneficial on CKD risk improvement in the patients with a moderate risk and very high-risk stage of CKD. There may be a synergistic interaction between obesity and cognitive function decline, and the synergistic interaction may increase the risk of CKD progression.
肥胖和认知功能下降是慢性肾脏病（CKD）的独立危险因素。然而，很少有研究探讨肥胖状况和认知功能对 CKD 风险变化的综合影响。我们旨在评估 2 型糖尿病（T2DM）患者的肥胖状况、认知功能与 CKD 风险变化之间的关系。
从 2006 年至 2018 年，从糖尿病疾病管理计划中提取了 3399 名 T2DM 患者的数据。采用单变量和多变量分析评估肥胖、认知下降与 CKD 风险变化之间的关系。采用相对超额交互作用风险比（RERI）、交互归因比例（API）和协同指数（SI）三个指标分析交互作用。根据 KDIGO 2012 CKD 定义对 CKD 风险进行分类。
在多变量分析中，与正常体重患者相比，中重度肥胖患者的 CKD 风险进展的危险比（HR，95%CI）高 1.34（1.12-1.61）倍，而 MMSE 评分≤18 的患者比 MMSE 评分≥24 的患者高 1.34（1.06-1.67）倍。中重度肥胖和 MMSE 评分≤18 对 CKD 风险进展有协同交互作用（SI=4.461；95%CI：1.998-9.962），这种交互作用导致 CKD 风险进展的比例为 52.7%（API=0.527；95%CI：0.295-0.759）。然而，对于 CKD 中危和极高危阶段的患者，正常体重和 MMSE 评分≥24 对 CKD 风险改善没有益处。
肥胖和认知功能下降之间可能存在协同交互作用，这种协同交互作用可能会增加 CKD 进展的风险。
