内脏脂肪指数与糖尿病患者肾病结局的相关性：来自 ACCORD 试验的结果。

Associations between visceral adiposity index and incident nephropathy outcomes in diabetic patients: Insights from the ACCORD trial.

机构信息

Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.

出版信息

Diabetes Metab Res Rev. 2023 Mar;39(3):e3602. doi: 10.1002/dmrr.3602. Epub 2022 Dec 30.

DOI:10.1002/dmrr.3602

PMID:36546623

Abstract

AIMS

Visceral adiposity index (VAI) was a reliable marker for visceral adiposity accumulation and dysfunction. The association between VAI and nephropathy outcomes remains uncertain in patients with type 2 diabetes (T2DM). We aimed to evaluate the longitudinal relationships between VAI and incident nephropathy outcomes in T2DM patients.

MATERIALS AND METHODS

Ten thousand one hundred and thirty two participants with T2DM from the ACCORD trial were included in the present study. Cumulative average VAI based on VAI measurements at baseline and follow-up was used to represent long-term VAI status. The primary outcome was the incident composite nephropathy outcome defined as: (1) serum creatinine doubling or >20 ml/min decrease in eGFR; or (2) development of macro-albuminuria; or (3) renal failure or end stage kidney disease (dialysis) or serum creatinine >3.3 mg/dl.

RESULTS

During 26,168 person-years follow-up duration, 6094 (60.1%) participants developed the incident composite nephropathy outcome. When assessing cumulative average VAI as quartiles, compared with those in the 1-2 quartiles (<2.6), a significantly higher risk of incident composite nephropathy outcomes was observed among participants in the 3-4 quartiles (≥2.6, adjusted HR: 1.09, 95% CI: 1.01, 1.18). Moreover, the positive association was consistent in participants with or without single abnormal VAI components, including general obesity, abdominal obesity, elevated triglycerides, and low high-density lipoprotein cholesterol, or with different numbers of abnormal VAI components. Additionally, the positive association was stronger in participants with cumulative average systolic blood pressure <130 mmHg (vs. ≥130 mmHg; p-interaction < 0.001).

CONCLUSIONS

In T2DM patients, higher cumulative average VAI was associated with a higher risk of incident composite nephropathy outcomes.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, identifier: NCT00000620.

摘要

目的

内脏脂肪指数（VAI）是内脏脂肪堆积和功能障碍的可靠标志物。VAI 与 2 型糖尿病（T2DM）患者肾病结局的相关性尚不确定。我们旨在评估 VAI 与 T2DM 患者发生肾病结局的纵向关系。

材料和方法

本研究纳入了 ACCORD 试验中的 10132 名 T2DM 患者。基于基线和随访时的 VAI 测量值，计算累积平均 VAI 以代表长期 VAI 状况。主要结局为复合肾病结局的发生，定义为：（1）血清肌酐翻倍或 eGFR 下降>20ml/min；（2）出现大量白蛋白尿；（3）肾衰竭或终末期肾病（透析）或血清肌酐>3.3mg/dl。

结果

在 26168 人年的随访期间，6094 名（60.1%）参与者发生了复合肾病结局。在评估累积平均 VAI 四分位数时，与第 1-2 四分位数（<2.6）相比，第 3-4 四分位数（≥2.6）参与者发生复合肾病结局的风险显著更高（调整 HR：1.09，95%CI：1.01，1.18）。此外，在具有或不具有单一异常 VAI 成分（包括一般肥胖、腹部肥胖、甘油三酯升高和低高密度脂蛋白胆固醇）或具有不同数量异常 VAI 成分的参与者中，这种正相关关系是一致的。此外，在累积平均收缩压<130mmHg 的参与者中（与≥130mmHg 相比；p 交互<0.001），这种正相关关系更强。