Association of baseline and changes in estimated glucose disposal rate and risk of chronic kidney disease: evidence from a national longitudinal study.

Objective: This study explored the relationship between baseline estimated glucose disposal rate (eGDR), its trajectories, and the risk of chronic kidney disease (CKD).

Methods: Participants from the China Health and Retirement Longitudinal Study were included. eGDR was calculated using a validated formula, and CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73m2 or self-reported. Group-based trajectory modeling identified distinct eGDR patterns, and Cox proportional hazards models assessed associations between eGDR and CKD risk.

Results: A total of 5,238 participants were analyzed, with 436 incident CKD cases during the 5-year follow-up. Higher baseline eGDR (≥ 8 mg/kg/min) was associated with a reduced CKD risk (Hazard Ratio [HR] = 0.40; 95% Confidence Interval [CI]: 0.19-0.88; P = 0.022). An L-shaped relationship was observed between eGDR and CKD risk. Three eGDR trajectories were identified: low-stability (41.8%), decreasing (14.5%), and high-stability (43.7%). Only the high-stability trajectory significantly reduced CKD risk (HR = 0.77; 95% CI: 0.62-0.96; P = 0.019) compared to the low-stability group.

Conclusion: Higher baseline eGDR and consistently high eGDR trajectories were linked to a lower CKD risk, highlighting the significance of maintaining insulin sensitivity for CKD prevention.