心血管代谢共病患者相对脂肪质量指数与估算肾小球滤过率下降的相关性探究OA

Background Patients with cardiometabolic comorbidity(CMM)are at high risk of kidney damage,but traditional obesity indicators(such as BMI)have limited efficacy in predicting renal risk.Relative fat mass index(RFM)estimates body fat distribution by waist circumference and height,which may be more suitable for risk assessment in this population.Objective To investigate the correlation between RFM and estimated glomerular filtration rate(eGFR)in patients with CMM.Methods A cross-sectional study design was adopted,and cluster sampling was used to conduct a survey among the permanent residents of 12 counties and cities participating in the Early Screening and Comprehensive Intervention Project for High-risk Population of CVD in Anhui Province from 2021 to 2023.A total of 2 421 patients with cardiometabolic diseases were included in this study,and their demographic characteristics,clinical indicators and renal function data were collected.BMI,RFM,body shape index(ABSI),C-index and body roundness index(BRI)were calculated.Patients were divided into normal eGFR group and decreased eGFR group according to eGFR<90 mL·min-1·(1.73 m2)-1.Multivariate Logistic regression analysis was used to explore the association between RFM and eGFR,and restricted cubic spline was used to test the dose-response relationship.The receiver operating characteristic(ROC)curve was drawn to demonstrate the predictive value of RFM for the decline of glomerular filtration rate.Results There were 1 887 patients in the normal eGFR group and 534 patients in the decreased eGFR group,and the prevalence of decreased eGFR was 22.1%(534/2 421).After adjusting for confounding factors,multivariate Logistic regression analysis showed that the risk of decreased eGFR increased with the increase of RFM(OR=1.032,95%CI=1.004-1.061,P<0.05).RFM Q2(27≤RFM<35),RFM Q3(35≤RFM<39),and RFM Q4(RFM≥39)had 2.861 times(95%CI=1.716-4.770,P<0.01)higher risk of decreased eGFR than RFM Q1(RFM<27),3.658(95%CI=1.978-6.767,P<0.01),3.714(95%CI=2.001-6.892,P<0.01).The restricted cubic spline results showed that there was a nonlinear relationship between RFM and the risk of decreased eGFR(Pnonlinear<0.01).There was an obvious inflpoint at RFM ≈36,beyond which the risk showed a significant upward trend.The higher the RFM,the higher the risk of decreased eGFR.ROC curve results showed that the area under the ROC curve(AUC)of RFM for predicting eGFR decline in CMM patients was 0.686(95%CI=0.671-0.701),which was higher than that of BMI(0.530)(Z=2.143,P<0.01),AUC of C-index(0.622)(Z=10.538,P<0.01),AUC of ABSI(0.670)(Z=11.308,P<0.01)and AUC of BRI(0.591)(Z=4.929,P<0.01).Conclusion RFM index is independently associated with the risk of eGFR decline in CMM patients.RFM≥35 can be used as a clinical warning threshold.