Association of dysfunctional adiposity index with kidney impairment is accounted for by pigment epithelium-derived factor in type 2 diabetes mellitus - An 11-year follow-up of the SMART2D cohort study.

AIMS: This novel longitudinal study investigated the association of the new dysfunctional adiposity index (DAI) with kidney impairment in multi-ethnic Asians with type 2 diabetes mellitus (T2DM), and the mediation effect of pigment epithelium-derived factor (PEDF).

METHODS

T2DM adults followed for up to 10.5 years were analyzed (n = 1611). DAI was calculated using a sex-specific formula. Baseline plasma PEDF levels were quantified using immunoassay. Diabetic kidney disease (DKD) was defined as presence of chronic kidney disease and/or albuminuria. The longitudinal outcomes included ≥40 % decline in estimated glomerular filtration rate from baseline (significant eGFR decline), albuminuria progression, and end-stage kidney disease (ESKD).

RESULTS

Baseline DAI was associated with kidney parameters and DKD cross-sectionally, and showed increased discrimination ability. DAI was correlated with PEDF (rho = 0.324, P < 0.001). Additionally, DAI predicted significant eGFR decline (35.8 % prevalence) in the unadjusted (hazard ratio = 1.49, 95 % CI:1.31-1.70) and covariate-adjusted (hazard ratio = 1.23, 95 % CI:1.06-1.41) models; and was associated with ESKD and albuminuria progression. The relationship between DAI and significant eGFR decline was attenuated after accounting for PEDF, which explained 53.6 % of the indirect effect of DAI on significant eGFR decline.

CONCLUSIONS

Elevated DAI and its associated PEDF may serve as useful indicators for kidney function decline in T2DM.