Estimating Glucose Disposal Rate and Its Association with All-Cause and Etiologically Specific Mortality in Cardiovascular-Kidney-Metabolic Syndrome among US Adults: Insights from NHANES 1999-2018.

Background: The estimated glucose disposal rate (eGDR) is a useful indicator of insulinresistance. Thisstudy explores its asociation with cadiovascular-kidney-metabolic syndrome (CKM), a relationship that has rarely been investigated. The aim of this research was toexamine potential correlations between eGDR and CKM.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. eGDR was categorized into three quartiles: Q1, Q2, and Q3. Weighted multivariate cox regression models, competing risk models and restricted cubic spline (RCS) models were applied to investigate the association between eGDR and mortality outcomes, including all-cause and cause-specific mortality. Subgroup analysis was performed to test the robustness of the results.

Results: Of the 14,074 patients with CKM, 2,426 died, including 767 from cardio-cerebrovascular disease and 39 from kidney disease. After adjustment for all potential confounders, weighted multivariate cox models showed that eGDR was inversely associated with mortality from all causes and with mortality from cardio-cerebrovascular (p < 0.05), but not with mortality from kidney disease (p > 0.05). The RCS model further confirmed the linear relationship between eGDR all-cause cardio-cerebrovascular, with statistical evidence supporting this (p for nonlinear >0.05). Even when using non-cardiovascular-cerebrovascular mortality as a competitive risk, the adjusted Fine-Gray model demonstrated that eGDR remains an independent predictor of cardiovascular-cerebrovascular mortality (SHR 0.560, 95% CI 0.460-0.680, p < 0.001).

Conclusion: Our findings reveal a significant inverse association between eGDR and the risk of both all-cause and cardio-cerebrovascular mortality in patients with CKM. This suggests that higher levels of eGDR are linked to a lower risk of death from these causes, indicating that improving insulin sensitivity may have protective effects on survival outcomes in CKM patients.