Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China.
BMC Med. 2024 Sep 27;22(1):411. doi: 10.1186/s12916-024-03582-x.
Evidence suggests that insulin resistance (IR) is an autonomous risk factor for cardiovascular disease (CVD). Nevertheless, the association between estimated glucose disposal rate (eGDR), a novel indicator of IR, and incident CVD and mortality in chronic kidney disease (CKD) patients without diabetes remains uncertain.
The study included 19,906 participants from the UK Biobank who had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m or a urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g and no history of CVD and diabetes. Individuals were divided into three categories based on tertiles of eGDR. The outcome was a composite CVD (coronary heart disease (CHD) and stroke) and mortality (all-cause, non-accidental, and cardiovascular mortality). Furthermore, a cohort of 1,600 individuals from the US National Health and Nutrition Examination Survey (NHANES) was applied to validate the association between eGDR and mortality. The Cox proportional hazards regression models were used to examine the association between eGDR and event outcomes.
During a follow-up of around 12 years, 2,860 CVD, 2,249 CHD, 783 stroke, 2,431 all-cause, 2,326 non-accidental and 492 cardiovascular deaths were recorded from UK Biobank. Higher eGDR level was not only associated with lower risk of CVD (hazard ratio [HR] 0.641, 95% confidence interval [CI] 0.559-0.734), CHD (HR 0.607, 95% CI 0.520-0.709), stroke (HR 0.748, 95% CI 0.579-0.966), but also related to reduced risk of all-cause (HR 0.803, 95% CI 0.698-0.923), non-accidental (HR 0.787, 95% CI 0.682-0.908), and cardiovascular mortality (HR 0.592, 95% CI 0.423-0.829). Validation analyses from NHANES yielded consistent relationship on mortality.
In these two large cohorts of CKD patients without DM, a higher eGDR level was associated with a decreased risk of CVD and mortality.
有证据表明，胰岛素抵抗（IR）是心血管疾病（CVD）的一个自主风险因素。然而，在没有糖尿病的慢性肾脏病（CKD）患者中，估计葡萄糖处置率（eGDR）与 CVD 事件和死亡率之间的关系仍不确定，eGDR 是一种新的 IR 指标。
这项研究纳入了英国生物库的 19906 名参与者，他们的估计肾小球滤过率（eGFR）<60 ml/min/1.73m 或尿白蛋白与肌酐比值（UACR）≥30 mg/g，且无 CVD 和糖尿病病史。根据 eGDR 的三分位数，将个体分为三组。主要结局为复合 CVD（冠心病（CHD）和中风）和死亡率（全因、非意外和心血管死亡率）。此外，还应用了来自美国国家健康和营养检查调查（NHANES）的 1600 名个体的队列来验证 eGDR 与死亡率之间的关联。采用 Cox 比例风险回归模型来检验 eGDR 与事件结局之间的关系。
在大约 12 年的随访期间，英国生物库记录了 2860 例 CVD、2249 例 CHD、783 例中风、2431 例全因、2326 例非意外和 492 例心血管死亡。较高的 eGDR 水平不仅与较低的 CVD 风险相关（风险比 [HR]0.641，95%置信区间 [CI]0.559-0.734）、CHD（HR0.607，95%CI0.520-0.709）和中风（HR0.748，95%CI0.579-0.966），还与全因（HR0.803，95%CI0.698-0.923）、非意外（HR0.787，95%CI0.682-0.908）和心血管死亡（HR0.592，95%CI0.423-0.829）风险降低相关。来自 NHANES 的验证分析得出了死亡率方面的一致关系。
在这两个没有 DM 的 CKD 患者的大型队列中，较高的 eGDR 水平与 CVD 和死亡率降低相关。
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