The Association Between Hypertriglyceridemic-Waist Phenotype and Chronic Kidney Disease in Patients with Type 2 Diabetes: A Cross-Sectional METAL Study

Figures & data

Figure 1 Flow chart of study participant selection (inclusions and exclusions).

Table 1 Characteristics of the Participants in Each Phenotype Group (n = 4254)

	NWNT	NWET	EWNT	HTGW	P for Trend
No. of participants (%)	790(18.6)	1661(39.0)	319(7.5)	1484(34.9)
Age at baseline (year)	66.13±8.83	67.33±9.03	64.89±9.29	66.41±8.85	<0.001
Male (%)	541(68.5)	690(41.6)	193(60.5)	559(37.7)	0.192
BMI (kg/m^2)	21.68±2.34	25.66±3.18	22.41±2.25	26.32±3.33	<0.001
WC (cm)	79.38±6.41	92.68±8.07	80.56±6.05	94.02±8.37	<0.001
SBP (mmHg)	138.32±20.13	144.40±19.43	141.99±19.53	146.37±19.28	<0.001
DBP (mmHg)	76.81±10.62	78.40±10.72	79.40±10.54	81.00±10.54	<0.001
FBG (mmol/L)	6.95±2.26	7.15±2.18	7.27±2.40	7.81±2.69	<0.001
HbA1C (%)	7.00±1.43	7.15±1.31	7.16±1.47	7.41±1.44	<0.001
HOMA-IR	1.53(1.03–2.34)	1.99(1.55–3.69)	2.38(1.39–6.24)	3.03(2.07–4.63)	<0.001
TG (mmol/L)	1.07±0.31	1.20±0.29	2.68±1.29	2.92±2.04	<0.001
TC (mmol/L)	4.99±1.15	4.89±1.11	5.61±1.15	5.51±1.20	<0.001
HDL-C (mmol/L)	1.37±0.35	1.28±0.29	1.15±0.26	1.11±0.23	<0.001
LDL-C (mmol/L)	3.05±0.83	3.03±0.82	3.47±0.81	3.39±0.83	<0.001
ALT (U/L)	20.05±16.09	21.73±13.64	21.62±14.98	25.49±20.50	<0.001
AST (U/L)	22.87±9.64	23.17±9.75	23.07±11.28	24.83±15.14	<0.001
eGFR (mL/m/1.73 m^2)	101.89±11.13	92.87±12.01	87.89±11.25	82.53±12.09	0.078
UACR (mg/dl)	10(6–19)	13(8–29)	14(7–28)	16(9–40)	<0.001
UA (μmol/L)	302.57±75.48	317.30±77.86	332.79±79.41	346.11±80.18	<0.001
CKD, (%)	160(20.2)	464(27.9)	93(29.1)	531(35.8)	<0.001
Male (%)	114(71.3)	203(43.8)	56(60.2)	182(34.2)	<0.001
Hypertension (%)	414(50.5)	1182(68.9)	196(58.2)	1148(74.5)	<0.001
Overweight/obesity (%)	161(20.4)	1446(87.1)	95(29.9)	1381(93.1)	<0.001
Current smoking (%)	207(25.2)	225(13.1)	87(27.3)	261(17.6)	<0.001
Current drinking (%)	163(20.7)	241(14.5)	58(18.4)	224(15.1)	<0.001
Treatment of diabetes	603(76.3)	1323(79.7)	236(70.0)	1208(81.4)	<0.001
Oral-drug (%)	542(89.9)	1191(90)	209(88.6)	1115(92.3)	<0.001
Insulin (%)	119(19.7)	273(20.6)	41(17.3)	201(16.6)	<0.001

Abbreviations: BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin A1c; HOMA-IR, homeostasis model assessment of insulin resistance; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; UACR, urinary albumin–creatinine ratio; eGFR, estimated glomerular filtration rate; UA, uric acid; CKD, chronic kidney disease.

Table 2 Odds Ratios for CKD with Triglyceride Waist Phenotypes

	Model 1		Model 2
	OR (95% CI)	P	OR (95% CI)	P
CKD
NWNT	Ref	Ref	Ref	Ref
NWET	1.14(0.89,1.44)	0.287	1.00(0.76,1.31)	0.996
EWNT	1.55(1.14,2.11)	0.006	1.42(0.98,2.04)	0.062
HTGW	1.67(1.15,2.12)	<0.001	1.47(1.11,1.95)	0.007
Decreased eGFR
NWNT	Ref	Ref	Ref	Ref
NWET	0.91(0.58,1.43)	0.081	0.95(0.65,1.40)	0.715
EWNT	1.55(0.49,4.79)	0.451	1.13(0.83,1.53)	0.806
HTGW	1.79(1.03,3.13)	0.040	1.31(1.02,1.75)	0.029
Elevated uACR
NWNT	Ref	Ref	Ref	Ref
NWET	1.22(0.96,1.55)	0.584	1.38(0.97,1.96)	0.555
EWNT	1.45(1.05,2.00)	0.024	1.32(0.90,1,98)	0.154
HTGW	1.79(1.39,2.29)	<0.001	1.57(1.18,2.11)	0.002

Notes: Model 1 was adjusted for age, sex, BMI, current smoking and current drinking. Model 2 was adjusted for Model 1 plus TC, LDL, HbA1c, UA, FBG, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, hypertension and anti-hypertension agents.

Table 3 Associations of Triglyceride Waist Phenotypes with ACR and eGFR

	eGFR		Ln ACR
	β (95% CI)	P	β (95% CI)	P
Total
NWNT	Ref	Ref	Ref	Ref
NWET	−0.02(−2.48,0.61)	0.234	−0.02(−1.18,0.08)	0.463
EWNT	−0.04(−4.89, −0.86)	0.005	0.03(−0.02, 0.32)	0.090
HTGW	−0.07(−3.68, −1.39)	<0.001	0.07(0.09, 0.28)	<0.001
Men
NWNT	Ref	Ref	Ref	Ref
NWET	0.04(−0.60, 3.25)	0.178	−0.03(−0.20,0.18)	0.917
EWNT	−0.05(−4.62, 0.23)	0.076	0.04(−0.05,0.44)	0.115
HTGW	−0.12(−5.65, −2.44)	<0.001	0.07(0.04,0.36)	0.017
Women
NWNT	Ref	Ref	Ref	Ref
NWET	0.01(−1.75, 2.25)	0.803	−0.01(−0.23,0.16)	0.739
EWNT	−0.07(−6.70, −1.64)	0.001	0.02(−0.14,0.37)	0.377
HTGW	−0.08(−3.39, −0.96)	<0.001	0.08(0.07,0.31)	0.002

Notes: Model was adjusted for age, sex, BMI, current smoking and current drinking plus TC, LDL, FBG, HbA1c, UA, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, hypertension and anti-hypertension agents.

Table 4 Odds Ratios for CKD According to Triglyceride Waist Phenotypes by Various Subgroups

Subpopulation	Cases/Participants		NWNT	NWET	EWNT	HTGW	P-Trend	P-Interaction
Age, years^a
<65	1938/4254		1.00 (ref)	1.18 (0.86,1.63)	1.71 (1.23,2.36)	1.43 (1.02,3.13)	<0.001	0.542
≥65	2316/4254		1.00 (ref)	0.91 (0.75,1.12)	1.59 (1.28,1.99)	1.82 (1.01,3.10)	<0.001
Gender^b
Male	1983/4254		1.00 (ref)	1.06 (0.82,1.37)	1.72 (1.38,2.14)	1.31 (1.20,1.42)	<0.001	0.678
Female	2271/4254		1.00 (ref)	1.04 (0.81,1.33)	1.27 (0.91,1.78)	1.44 (1.11,1.88)	0.008
BMI, kg/m^2,c
< 24	1403/4254		1.00 (ref)	1.57 (1.35,1.82)	1.73 (1.44,2.08)	2.13 (1.47,3.08)	<0.001	0.784
≥ 24	2851/4254		1.00 (ref)	1.45 (0.86,2.45)	1.21 (0.54,2.72)	1.38 (1.01,2.85)	<0.001
HbA1c, %^d
<7	2581/4254		1.00 (ref)	1.04 (0.66,1.62)	1.23 (0.65,2,17)	1.53 (0.95,2.79)	0.078	0.458
≥7	1673/4254		1.00 (ref)	1.19 (0.73,1.96)	2.21 (1.31,3.76)	2.97 (1.58,5.56)	0.001
Presence of Hypertension^e
No	1430/4254		1.00 (ref)	1.64 (1.41,1.89)	1.94 (1.61,2.33)	1.32 (1.05,1.77)	<0.001	0.262
Yes	2821/4254		1.00 (ref)	1.01 (0.60,1.72)	1.21 (0.31,2.72)	3.46 (1.56,7.69)	<0.001

Notes: ^aFor age subgroup: adjusted for sex, BMI, LDL-C, HDL-C, TC, FBG, HbA1c, UA, current smoking and current drinking, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, hypertension, antihypertension drug; ^bFor gender subgroup: adjusted for age, BMI, LDL-C, HDL-C, TC, FBG, HbA1c, UA, current smoking and current drinking, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, anti-hypertension drug; ^cFor BMI subgroup: adjusted for age, sex, LDL-C, HDL-C, TC, FBG, HbA1c, UA, current smoking and current drinking, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, hypertension, anti-hypertension drug; ^dFor HbA1c subgroup: adjusted for age, sex, BMI, LDL-C, HDL-C, TC, FBG, UA, current smoking, current drinking, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, hypertension, anti-hypertension drug; ^eFor drink status subgroup: adjusted for age, sex, BMI, LDL-C, HDL-C, TC, FBG, HbA1c, UA, current smoking, current drinking, systolic blood pressure, diastolic blood pressure, anti-diabetes agents, antihypertension drug (only for hypertension group).