Trajectories of Fasting Plasma Glucose and Risks of Chronic Kidney Disease in a General Chinese Population: A Retrospective Study

Abstract

Aim

To investigate the association between longitudinal changing patterns of fasting plasma glucose (FPG), and kidney function change in the general population.

Methods

We conducted a retrospective, longitudinal cohort study of a health examination center database in China. Subjects who had at least three visits from 2011 to 2018 with baseline eGFR ≥60 mL/min/1.73 m² were enrolled. The FPG trajectories were identified by group-based trajectory modeling (GBTM). We examined the association of eGFR slopes and FPG trajectories by Cox analysis.

Results

Totally, 8114 participants were identified. Three heterogeneous FBP trajectories were detected by GBTM as low-stable group (n=7294), moderate-stable group (n=657) and high-stable group (n=163). The high-stable group had lower baseline eGFR, a higher percentage of fast eGFR slope, lower HDL-c, higher LDL-c, higher cholesterol, and higher Lg(triglyceride). Cox analysis showed that the high-stable trajectory was a risk factor for fast eGFR decline (for eGFR slope <−4 mL/min per 1.73 m² per year, adjusted HR [95% CI] 1.544 [0.876, 2.722]; for eGFR slope <−5 mL/min per 1.73 m² per year, adjusted HR [95% CI] 2.117[1.100, 4.075]). Further, we analyzed a subgroup in which participants’ long-term FPG was normal. We divided this subgroup into four trajectories by GBTM, and Cox analysis showed that after adjustment for other potential confounding factors, the high-stable trajectory was an independent risk factor for fast eGFR slope (for eGFR slope <−4 mL/min per 1.73 m² per year, adjusted HR [95% CI] HR 1.640[1.050, 2.561]; for eGFR slope <−5 mL/min per 1.73 m² per year, adjusted HR [95% CI] 1.818[1.018, 3.248]) in subgroup.

Conclusion

We found that discrete FPG trajectories were significantly associated with risk of fast eGFR slope in individuals and those with long-term normal FPG. These observations suggest the importance of early prevention of CKD among individuals who are high-glycemic and normoglycemic.

Keywords:

• fasting plasma glucose
• trajectory
• chronic kidney disease

Data Sharing Statement

The data used to support the findings of this study is available from the corresponding author upon request.

Ethical Approval

This study was approved by the Institutional Review Board of the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (No. 201029) and was in accordance with the principles of the Helsinki Declaration II. Informed consent was waived by the ethics committee as all the data were collected after de-identification. The data were only accessible to the principal investigator, ensuring confidentiality. The information was kept confidential throughout the entire study.

Acknowledgments

This study is supported by grants from the National Key Research and Development Program (2016YFC1305402), National Natural Science Foundation of China (81700647, 81870492) and Key Projects of National Basic Research Program of China 973 (2012CB517700).

Disclosure

The authors report no conflicts of interest in this work.