Association of evaluated glomerular filtration rate and incident diabetes mellitus: a secondary retrospective analysis based on a Chinese Cohort Study

Abstract Background: Previous studies have revealed that chronic kidney disease (CKD) is one of major risk factors of insulin resistance and diabetes. However, there are few investigations of the correlations between the estimated glomerular filtration rate (eGFR) and incident diabetes, especially in Chinese population. This study was taken to explore the relationship between eGFR and incident diabetes in a large cohort in Chinese community population. Methods: The present study was a retrospective cohort study. A total of 199,435 adults from Rich Healthcare Group in China, which includes all medical records for participants who received a health check from 2010 to 2016. The target independent variable and the dependent variable were eGFR measured at baseline and incident diabetes mellitus appeared during follow-up respectively. Covariates involved in this study included age, gender, body mass index, diastolic blood pressure, systolic blood pressure, fasting plasma glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglyceride, alanine aminotransferase, aspartate aminotransferase, smoking and drinking status and family history of diabetes. Cox proportional-hazards regression was used to investigate the association between eGFR and incident diabetes. Generalized additive model was used to identify non-linear relationships. Additionally, we also performed a subgroup analysis. It was stated that the data had been uploaded to the DATADRYAD website. Result: After adjusting gender, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglyceride, alanine aminotransferase, aspartate aminotransferase, smoking and drinking status and family history of diabetes, result showed eGFR was negatively associated with incident diabetes (HR=0.987, 95%CI (0.984, 0.989)). A J shape relationship was detected between eGFR and incident diabetes, which had an inflection point of eGFR was 97.967 mL/min-1·(1.73 m2)-1. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.999 (0.994,1.004) and 0.977 (0.974,0.981), respectively. Subgroup analysis showed, the stronger association can be found in the population with FPG<6.1mmol/L, BMI<24kg/m2, SBP<140mmHg, DBP<90mmHg, HDL in middle level and family history without diabetes. The same trend was also seen in men and in the population with never or ever smoking. Conclusion: eGFR is independently associated with incident diabetes. The relationship between eGFR and incident diabetes is also non-linear. eGFR was strong negatively related to incident diabetes when eGFR is above 97.967 mL/min-1·(1.73 m2)-1.