A cohort study of correlation between fasting plasma glucose trajectory and new-onset chronic kidney disease in elderly population in Nanjing

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Objective: To explore the correlation between fasting plasma glucose (FPG) trajectory and new-onset chronic kidney disease (CKD) in elderly population (≥65 years old) in Nanjing. Methods: The study cohort was composed of 14 763 subjects who met the inclusion criteria in the population in elderly health examination in Nanjing. Based on the FPG levels detected in health examination from 2018 to 2021 (logarithm was used for normal distribution), three different FPG trajectory groups were determined using the SAS Proc Traj program, i.e. low-stable group, medium-stable group, and high-stable group. The incidence of CKD in 2022 was analyzed, and log-rank test was performed to compare the differences of cumulative incidence of new-onset CKD among different trajectory groups. Cox proportional hazards regression model was used to analyze the correlation between different FPG trajectories and new-onset CKD. Results: The mean follow-up time was (416.09±81.96) days. The follow-up time of the 500th day was selected to analyze the cumulative incidence rate of CKD in different FPG trajectory groups, and the cumulative incidence rate of CKD in the low-stable group, the medium-stable group, and the high-stable group of FPG increased with elevated trajectory, which was 15.3%, 21.8%, and 29.3%, respectively (log-rank test χ²=151.16, P<0.001). Cox proportional hazards regression model analysis showed that compared with the low-stable group, the medium-stable group and the high-stable group were all at risk for new-onset CKD. After adjusting for multiple confounding factors, the analysis by Cox proportional hazards regression model 4 indicated that the risk for CKD in medium-stable and high-stable groups were still 1.676 (95%CI: 1.462-1.921) times and 2.007 (95%CI: 1.562-2.579) times higher than that in low-stable group. Conclusions: Elevated FPG change trajectory level is a risk factor for new-onset CKD, and persistently high level of FPG increase the risk for CKD. FPG should be monitored in elderly population by follow up, and individualized prevention and control measures for CKD should be developed for different trajectory groups.