Association between prediabetes and nephropathy: a comprehensive systematic review and meta-analysis.

Abstract

Background: This study examines the association between prediabetes and nephropathy, focusing on chronic kidney disease and key indicators such as glomerular filtration rate and urinary albumin-to-creatinine ratio.

Methods: A systematic review of studies published before November 2024 included 26 articles, 15 cohort studies, and 11 cross-sectional studies, covering 350,546 individuals with normal glucose tolerance and 146,547 with prediabetes. A random-effects restricted maximum likelihood model was used to assess chronic kidney disease, glomerular filtration rate, and urinary albumin-to-creatinine ratio. The risk of chronic kidney disease was reported using relative risk (RR) with 95% confidence intervals, while mean difference (MD) was used for glomerular filtration rate and urinary albumin-to-creatinine ratio. Publication bias and methodological quality were assessed using the Egger regression test and the National Heart, Lung, and Blood Institute quality assessment tools. Sensitivity was tested using a leave-one-out method.

Results: Data from 19 studies showed that individuals with prediabetes had a higher risk of developing chronic kidney disease (RR: 1.53; 95% CI: 1.30-1.81; P < 0.001), rising to 1.21 (95% CI: 1.78-2.73) when all three diagnostic methods were used. Across 31 observations, glomerular filtration rate declined by (MD: - 2.85; 95% CI: - 4.57 to - 1.13; P = 0.001). Urinary albumin-to-creatinine ratio increased in 21 observations (MD: 0.87; 95% CI: 0.19-1.55; P = 0.012). Stronger associations were observed in Asia than in Europe or the United States.

Conclusion: Prediabetes is linked to lower glomerular filtration rate and higher urinary albumin-to-creatinine ratio, indicating increased risk of chronic kidney disease. Early intervention may be beneficial.