Park Hye-Sun, Park Sang Ho, Seong Yeseul, Kim Hyo Jeong, Choi Hoon Young, Rhee Yumie, Park Hyeong Cheon, Jhee Jong Hyun
Division of Endocrinology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1298-1308. doi: 10.1002/jcsm.13475. Epub 2024 Apr 17.
The association between the adiponectin-to-leptin ratio (A/L ratio) and the risk of incident chronic kidney disease (CKD) is poorly understood. This study aimed to investigate the association between A/L ratio and the risk of incident CKD and to examine whether such a relationship varied according to sex and body composition.
In this prospective community-based cohort, participants with normal kidney function were analysed (N = 5192). The association between the A/L ratio at baseline and the risk of incident CKD, defined as two or more occasions with an estimated glomerular filtration rate of <60 mL/min/m or proteinuria of ≥1+ on a dipstick test during the follow-up period, was evaluated using multivariable Cox proportional hazards analyses. Subgroup analyses were conducted based on sex, body mass index (BMI) and the presence of sarcopenia.
The participants' mean age was 57.2 ± 8.3 years, and 53.2% were women. The A/L ratio was higher in men compared with women (1.5 [0.8-3.2] and 0.5 [0.3-0.9] μg/ng, P < 0.001). During a median follow-up of 9.8 [9.5-10.0] years, 417 incident CKD events occurred (8.7 per 1000 person-years). Men in the highest quartile of A/L ratio had a lower risk of incident CKD (adjusted hazard ratio [aHR], 0.57; 95% confidence interval [CI], 0.33-0.99) than those in the lowest quartile. Additionally, a 1.0 increase in A/L ratio was associated with a 12% decreased risk of incident CKD in men (aHR, 0.88; 95% CI, 0.80-0.97). However, no significant association was observed in women. In subgroup analysis stratified by BMI and the presence of sarcopenia, the association between a high A/L ratio and a reduced risk of incident CKD was consistent in men with a BMI < 23.0 kg/m and those with sarcopenia. However, no significant association was observed between men with a BMI ≥ 23.0 kg/m and those without sarcopenia.
A high A/L ratio is an independent marker of a reduced risk of incident CKD in men, especially in those with a BMI < 23.0 kg/m and sarcopenia.
脂联素与瘦素比值（A/L比值）与慢性肾脏病（CKD）发病风险之间的关联尚不清楚。本研究旨在探讨A/L比值与CKD发病风险之间的关联，并检验这种关系是否因性别和身体组成而异。
在这个基于社区的前瞻性队列研究中，对肾功能正常的参与者进行了分析（N = 5192）。使用多变量Cox比例风险分析评估基线时的A/L比值与CKD发病风险之间的关联，CKD定义为在随访期间估计肾小球滤过率<60 mL/min/m²达两次或更多次，或尿试纸检测蛋白尿≥1+。基于性别、体重指数（BMI）和肌肉减少症的存在进行亚组分析。
参与者的平均年龄为57.2±8.3岁，53.2%为女性。男性的A/L比值高于女性（1.5[0.8 - 3.2]与0.5[0.3 - 0.9]μg/ng，P<0.001）。在9.8[9.5 - 10.0]年的中位随访期间，发生了417例CKD事件（每1000人年8.7例）。A/L比值处于最高四分位数的男性发生CKD的风险低于最低四分位数的男性（调整后风险比[aHR]，0.57；95%置信区间[CI]，0.33 - 0.99）。此外，A/L比值每增加1.0，男性发生CKD的风险降低12%（aHR，0.88；95%CI，0.80 - 0.97）。然而，在女性中未观察到显著关联。在按BMI和肌肉减少症存在情况分层的亚组分析中，A/L比值高与CKD发病风险降低之间的关联在BMI<23.0 kg/m²的男性和有肌肉减少症的男性中是一致的。然而，BMI≥23.0 kg/m²的男性和无肌肉减少症的男性之间未观察到显著关联。
高A/L比值是男性CKD发病风险降低的独立标志物，尤其是在BMI<23.0 kg/m²和有肌肉减少症的男性中。
