Association between estimated glucose disposal rate and kidney function decline in different glucose tolerance statuses from the 4 C study

Aims: To investigate the association between estimated glucose disposal rate (eGDR) and kidney function decline among populations with different glucose tolerance statuses including normal glucose tolerance (NGT), prediabetes, and diabetes.

Methods: The present study analyzed 5,069 participants from a cohort study. The association between eGDR and kidney function decline was assessed using binary logistic regression. Restricted cubic splines (RCS) analyses were also performed to investigate the dose-dependent associations.

Results: During up to 5 years of follow-up, 116 (2.30%) individuals experienced kidney function decline. Binary logistic regression showed that an increased level of eGDR was associated with decreased risk of kidney function decline after full adjustment, in all participants (Q4 vs. Q1 HR 0.13, 95% CI 0.05-0.30, p = 0.001), prediabetes (Q4 vs. Q1HR 0.11, 95% CI 0.01-0.44, p = 0.007), and diabetes (Q4 vs. Q1 HR 0.06, 95% CI 0.00-0.37, p = 0.012), but not in those with NGT. RCS analyses suggested dose-dependent relationships of eGDR with the risk of kidney function decline in all participants (L-shaped curve) and those with prediabetes (inverted U-shaped curve) and diabetes (L-shaped curve).

Conclusions: The association between elevated baseline eGDR and reduced risk of kidney function decline was significant in participants with prediabetes and diabetes, but not in those with NGT. These dose-dependent associations may have important implications for the assessment of high-risk patients by healthcare professionals and may lead to the development of more tailored and effective prevention strategies.