Liu Yuanxin, Liu Mingda, Jiang Yuyin, Cui Siyuan, Tang Wei
Department of Endocrinology, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
The Core Laboratory, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Front Endocrinol (Lausanne). 2025 Jul 4;16:1507735. doi: 10.3389/fendo.2025.1507735. eCollection 2025.
Chronic kidney disease (CKD) is a widespread condition, marked by significant morbidity and mortality rates, particularly in individuals with comorbidities such as diabetes and hypertension. While insulin resistance (IR) has been linked to CKD, the traditional methods used to measure IR have inherent limitations. This necessitates the exploration of alternative indicators that can more accurately reflect the relationship between IR and CKD.
This study employed a cross-sectional design, utilizing data extracted from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013 to 2018. The study sample comprised 7423 participants. Comprehensive demographic, anthropometric, and laboratory data were collected and analyzed. The estimated glucose disposal rate (eGDR), along with established measures of insulin resistance such as HOMA-IR, QUICKI, and the TyG, TyG-BMI, and TyG-WC indices were computed. The relationships between these indices and CKD indicators, specifically the eGFR and UACR, were assessed using a combination of linear and logistic regression models. Additionally, the performance of these indices was evaluated using receiver operating characteristic (ROC) curve analysis.
Elevated levels of the eGDR were significantly correlated with improved kidney function and a reduced prevalence of chronic kidney disease (CKD) and albuminuria. The correlation coefficients (R²) demonstrated that eGDR had a stronger association with the estimated glomerular filtration rate (eGFR) at R²=0.1379 and with the urinary albumin-to-creatinine ratio (UACR) at R²=0.0816, compared to the traditional measures of insulin resistance. eGDR also declined progressively across worsening CKD stages (p for trend< 0.001), highlighting a dose-response relationship. Logistic regression analysis further revealed that higher eGDR levels were associated with a decreased risk of developing CKD and proteinuria. Additionally, the ROC curve analysis indicated that eGDR exhibited the highest predictive accuracy for CKD, with an area under the curve (AUC) of 0.75, and for proteinuria, with an area under the curve (AUC) of 0.68.
The eGDR has emerged as a reliable and practical marker of insulin resistance associated with CKD indicators, demonstrating stronger associations with eGFR and UACR compared to traditional measures like HOMA-IR, QUICKI, TyG, TyG-BMI and TyG-WC. The simplicity of calculating eGDR enhances its utility as a valuable tool for the early detection and management of CKD, potentially improving clinical outcomes.
慢性肾脏病（CKD）是一种普遍存在的疾病，具有较高的发病率和死亡率，尤其是在患有糖尿病和高血压等合并症的个体中。虽然胰岛素抵抗（IR）与CKD有关，但用于测量IR的传统方法存在固有局限性。这就需要探索能够更准确反映IR与CKD之间关系的替代指标。
本研究采用横断面设计，利用从2013年至2018年的国家健康和营养检查调查（NHANES）中提取的数据。研究样本包括7423名参与者。收集并分析了全面的人口统计学、人体测量学和实验室数据。计算了估计的葡萄糖处置率（eGDR）以及胰岛素抵抗的既定测量指标，如HOMA-IR、QUICKI以及TyG、TyG-BMI和TyG-WC指数。使用线性和逻辑回归模型相结合的方法评估这些指数与CKD指标（特别是eGFR和UACR）之间的关系。此外，使用受试者工作特征（ROC）曲线分析评估这些指数的性能。
eGDR水平升高与肾功能改善、慢性肾脏病（CKD）和蛋白尿患病率降低显著相关。相关系数（R²）表明，与胰岛素抵抗的传统测量指标相比，eGDR与估计肾小球滤过率（eGFR）的关联更强（R²=0.1379），与尿白蛋白与肌酐比值（UACR）的关联也更强（R²=0.0816）。随着CKD阶段的恶化，eGDR也逐渐下降（趋势p<0.001），突出了剂量反应关系。逻辑回归分析进一步表明，较高的eGDR水平与发生CKD和蛋白尿的风险降低有关。此外，ROC曲线分析表明，eGDR对CKD的预测准确性最高，曲线下面积（AUC）为0.75，对蛋白尿的曲线下面积（AUC）为0.68。
eGDR已成为与CKD指标相关的胰岛素抵抗的可靠实用标志物，与HOMA-IR、QUICKI、TyG、TyG-BMI和TyG-WC等传统测量指标相比，与eGFR和UACR的关联更强。计算eGDR简单易行，增强了其作为CKD早期检测和管理的有价值工具的实用性，有可能改善临床结局。
