Yiting Wu, Hao Xiang, Yu Huang, Yuanyuan Zhang, Ziliang Ye, Yanjun Zhang, Sisi Yang, Xiaoqin Gan, Yiwei Zhang, Chen Dan, Xianglian Cai, Xiaolong Liang, Sheng Nie, Fan Fan Hou, Xianhui Qin
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引用次数: 0
Abstract
Background: Biological aging (BA) may influence chronic kidney disease (CKD) development. We evaluated the association of accelerated BA-quantified using Klemera-Doubal method biological age (KDM-BA) and phenotypic age (PhenoAge)-with incident CKD, and assessed its predictive value beyond conventional risk factors (CKD Prediction Consortium [CKD-PC] model) in participants with diabetes.
Methods: This two-country cohort study included 14,274 participants with diabetes from the UK Biobank and 7,900 from the China Renal Data System (CRDS). KDM-BA and PhenoAge were calculated from clinical biomarkers, and their acceleration (deviation from chronological age) was evaluated. Cox regression assessed associations with incident CKD, while C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated predictive performance.
Results: Over median follow-ups of 13.3 (UK Biobank) and 3.3 (CRDS) years, 1,676 and 709 incident CKD cases were documented. Each standard deviation increase in KDM-BA acceleration was associated with 31% (95%CI: 23-39%) (UK) and 68% (95%CI: 58-80%) (China) higher CKD hazard. PhenoAge acceleration similarly increased CKD risk (29% and 28%, respectively). In the UK Biobank, adding KDM-BA or PhenoAge acceleration to the CKD-PC model (C-index = 0.770) led to modest but statistically significant improvements in prediction (C-index increase = 0.004 [95%CI: 0.002-0.006] and 0.003 [0.001-0.005], respectively), while leukocyte telomere length (LTL) provided no benefit (0.0001 [-0.0004, 0.0005]). Both BA measures enhanced reclassification (NRI: 0.034-0.076; IDI: 0.002-0.003). CRDS analyses yielded consistent results.
Conclusion: Accelerated BA is consistently associated with higher CKD hazard in diabetes across European and Asian populations. KDM-BA and PhenoAge offer practical tools for refining CKD risk stratification.
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