The visceral adiposity index as a predictor of chronic kidney disease; a systematic review and meta-analysis

Visceral Adiposity Index as a Predictor of Chronic Kidney Disease in a Relatively Healthy Population in Taiwan

We aimed to compare the relative strength of the association between anthropometric obesity indices and chronic kidney disease (CKD). Another objective was to examine whether the visceral adiposity index (VAI) and lipid accumulation product index (LAPI) can identify CKD in the rural population of China. There were 5168 males and 6024 females involved in this cross-sectional study, and 237 participants (2.12%) suffered from CKD. Obesity indices included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), VAI and LAPI. VAI and LAPI were calculated with triglyceride (TG), high-density lipoprotein (HDL), BMI and WC. VAI = [WC/39.68 + (1.88 × BMI)] × (TG /1.03) × (1.31/ HDL) for males; VAI = [WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL) for females. LAPI = (WC-65) × TG for males, LAPI = (WC-58) × TG for females. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2. The prevalence of CKD increased across quartiles for WHtR, VAI and LAPI. A multivariate logistic regression analysis of the presence of CKD for the highest quartile vs. the lowest quartile of each anthropometric measure showed that the VAI was the best predictor of CKD in females (OR: 4.21, 95% CI: 2.09–8.47, p < 0.001). VAI showed the highest AUC for CKD (AUC: 0.68, 95% CI: 0.65–0.72) and LAPI came second (AUC: 0.66, 95% CI: 0.61–0.70) in females compared with BMI (both p-values < 0.001). However, compared with the traditional index of the BMI, the anthropometric measures VAI, LAPI, WC, and WHtR had no statistically significant capacity to predict CKD in males. Our results showed that both VAI and LAPI were significantly associated with CKD in the rural population of northeast China. Furthermore, VAI and LAPI were superior to BMI, WC and WHtR for predicting CKD only in females.

Background: While it has been known that the development of chronic kidney disease (CKD) and age-related cognitive impairment involves several mediators, the evidence in clinical practice only reveals nitride oxide synthase (NOS) and klotho. However, the evidence for this topic is conflicted. The aim of this study was to assess the role of NOS and klotho single nucleotide polymorphisms (SNPs) in the pathogenesis of CKD and age-related cognitive impairment. Methods: We performed a meta-analysis during October to December 2019. Paper collection was performed in major scientific websites, and we extracted information of interest from each paper. Data were analyzed using a Z-test with either random or fixed effect model. Results: Our initial assessment identified NOS3 G894T, NOS3 T786C, NOS3 4b/4a, klotho ( KL) G395A, and KL C1818T as the gene candidate for our meta-analysis. Our pooled calculation revealed that NOS3 G894T was associated with the risk of both age-related cognitive impairment and CKD. Increased susceptibility to age-related cognitive impairment was observed in the GG genotype, and increased risk of CKD was found in patients with a single T allele and TT genotype for NOS3 nucleotide 894. For NOS3 4b/4a, increased risk of CKD was only found in 4a4a genotype. For NOS3 T786C, we failed to show the association with both CKD and age-related cognitive impairment. Subsequently, for KL G395A, A allele and GA genotype were found to correlate with increased susceptibility to CKD, while its correlation to age-related cognitive impairment was failed to clarify. For KL C1818T, our analysis failed to find the correlation with the risk of CKD. Conclusions: Our results reveal that the NOS3 G894T gene polymorphism has a crucial role in the pathogenesis of both CKD and age-related cognitive impairment.

Background: While it has been known that the development of chronic kidney disease (CKD) and age-related cognitive impairment involves several mediators, the evidence in clinical practice only reveals nitride oxide synthase (NOS) and klotho. However, the evidence for this topic is conflicted. The aim of this study was to assess the role of NOS and klotho single nucleotide polymorphisms (SNPs) in the pathogenesis of CKD and age-related cognitive impairment. Methods: We performed a meta-analysis during October to December 2019. Paper collection was performed in major scientific websites, and we extracted information of interest from each paper. Data were analyzed using a Z-test with either random or fixed effect model. Results: Our initial assessment identified NOS3 G894T, NOS3 T786C, NOS3 4b/4a, klotho ( KL) G395A, and KL C1818T as the gene candidate for our meta-analysis. Our pooled calculation revealed that NOS3 G894T was associated with the risk of both age-related cognitive impairment and CKD. Increased susceptibility to age-related cognitive impairment was observed in the GG genotype, and increased risk of CKD was found in patients with a single T allele and TT genotype for NOS3 nucleotide 894. For NOS3 4b/4a, increased risk of CKD was only found in 4a4a genotype. For NOS3 T786C, we failed to show the association with both CKD and age-related cognitive impairment. Subsequently, for KL G395A, A allele and GA genotype were found to correlate with increased susceptibility to CKD, while its correlation to age-related cognitive impairment was failed to clarify. For KL C1818T, our analysis failed to find the correlation with the risk of CKD. Conclusions: Our results reveal that the NOS3 G894T gene polymorphism has a crucial role in the pathogenesis of both CKD and age-related cognitive impairment.

Background: While it has been known that the development of chronic kidney disease (CKD) and age-related cognitive impairment involves several mediators, the evidence in clinical practice only reveals nitride oxide synthase (NOS) and klotho. However, the evidence for this topic is conflicted. The aim of this study was to assess the role of NOS and klotho single nucleotide polymorphisms (SNPs) in the pathogenesis of CKD and age-related cognitive impairment. Methods: We performed a meta-analysis during October to December 2019. Paper collection was performed in major scientific websites, and we extracted information of interest from each paper. Data were analyzed using a Z-test with either random or fixed effect model. Results: Our initial assessment identified NOS3 G894T, NOS3 T786C, NOS3 4b/4a, klotho ( KL) G395A, and KL C1818T as the gene candidate for our meta-analysis. Our pooled calculation revealed that NOS3 G894T was associated with the risk of both age-related cognitive impairment and CKD. Increased susceptibility to age-related cognitive impairment was observed in the GG genotype, and increased risk of CKD was found in patients with a single T allele and TT genotype for NOS3 nucleotide 894. For NOS3 4b/4a, increased risk of CKD was only found in 4a4a genotype. For NOS3 T786C, we failed to show the association with both CKD and age-related cognitive impairment. Subsequently, for KL G395A, A allele and GA genotype were found to correlate with increased susceptibility to CKD, while its correlation to age-related cognitive impairment was failed to clarify. For KL C1818T, our analysis failed to find the correlation with the risk of CKD. Conclusions: Our results reveal that the NOS3 G894T gene polymorphism has a crucial role in the pathogenesis of both CKD and age-related cognitive impairment.

The age-adjusted visceral adiposity index (AVAI) is a novel marker reflecting visceral fat-related metabolic risk. However, its relationship with chronic kidney disease (CKD) remains unclear. This study aims to evaluate the association between AVAI and CKD prevalence in U.S. adults. We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2018, including 7,760 participants aged 20 years and older. Logistic regression models were used to examine the association between AVAI and CKD, with adjustments for demographic, lifestyle, and clinical factors. Restricted cubic spline and threshold effect analyses were applied to explore the potential nonlinear patterns, and subgroup analyses assessed the potential effect modifiers. Receiver operating characteristic (ROC) curves compared the predictive performance of AVAI and the traditional visceral adiposity index (VAI). AVAI was significantly associated with higher CKD prevalence after adjustment, with each 1-unit increase corresponding to a 47% higher risk of CKD (OR = 1.47, 95% CI: 1.36–1.59). A nonlinear association was observed, with a threshold at AVAI = −6.5, beyond which CKD risk increased steeply. Subgroup analysis showed a stronger association in older adults. ROC analysis indicated that AVAI had better discriminatory ability for CKD (AUC = 0.7581) than VAI (AUC = 0.5685). These findings suggest that AVAI is a promising, practical tool for identifying individuals at high risk of CKD in the general population.

Background: In recent years, the impact of visceral fat accumulation on renal damage has garnered significant attention. However, whether visceral fat accumulation contributes to the incidence of both albuminuria and chronic kidney disease (CKD) is still uncertain. Our objective is to look into the possible correlation between visceral adiposity accumulation and incident increased urinary albumin excretion and CKD.Methods: We analyzed data from a cohort of 9916 subjects aged 40 years and above. As an innovative and convenient biomarker of visceral adiposity distribution, visceral adiposity index (VAI) was calculated in accordance with a gender-specific equation using measurement of blood lipids and anthropometric parameters of obesity. Albuminuria was determined by urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. CKD was determined by establishment of either of the following: (1) estimated glomerular filtration rate (eGFR) 60 mL/min per 1.73 m2 or less; (2) UACR ≥ 30 mg/g.Results: During an average follow-up period of 3.6 ± 0.7 years, 245 (4.7%) subjects developed albuminuria and 332 (6.3%) participants developed CKD. Incidence of albuminuria and CKD had a tendency to advance along with ascending VAI levels in both genders. According to multiple stepwise linear regression analysis, γ-glutamyltransferase (γ-GGT), fasting insulin, fasting plasma glucose (FPG), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) were independent determinants for VAI. Multivariate-adjusted hazard ratios (HRs) of albuminuria with 95% confidence intervals (CIs) in Cox regression analysis were 1 (reference), 0.82 (0.53–1.29), 1.50 (1.01–2.23), and 1.52 (1.02–2.26) in ascending quartiles of VAI. Similarly, the HRs with 95% CI of CKD in ascending quartiles of VAI were 1 (reference), 0.96 (0.66–1.41), 1.51 (1.07–2.15), and 1.56 (1.10–2.20). For subgroup analyses, VAI significantly correlated with risk of both albuminuria and CKD in older subjects (age ≥ 58 years), nondiabetes subjects, and non-ASCVD subjects (all p < 0.05).Conclusions: The greater deposition of visceral fat assessed by VAI is independently associated with risk of increased urinary albumin excretion and CKD in middle-aged and aged Chinese.

Background and Aims Central obesity may be linked to the risk for chronic kidney disease (CKD). The relationship between visceral obesity and early kidney injury is unclear. This study aimed to evaluate the association between the novel central obesity index, assessing metabolic score for visceral fat (METS-VF) and visceral adiposity index (VAI), and the risk for microalbuminuria and CKD in the adult population in Taiwan. Method This cross-sectional study included 2409 individuals’ aged ≧20 years from the CIJIN cohort in Kaohsiung city of Taiwan between September 2015 and December 2024. Demographic information, lifestyle, and medical history d were collected, and physical examinations and laboratory tests were performed for each participant. Microalbuminuria was defined as a urine albumin to creatinine ratio (UACR) ≧30 mg/g. CKD was defined as an estimated glomerular filtration rate (eGFR) calculated by CKD-EPI equations (GFR) &amp;lt; 60 ml/min/1.73 m2. Results The mean (±SD) age of participants was 48.8 (±15.8) years, 38.9 % was male, the mean eGFR was 102.8 (±18.2) ml/min/1.73 m2, and the mean UACR was 3.2 ± 17.3 mg/g. The participants in the highest tertile of the METS-VF had a significantly higher prevalence of microalbuminuria and CKD than those in the lowest tertile of the METS-VF (OR= 6.80 95% CI= 2.02–22.90, P = 0.002 for microalbuminuria; OR= 30.52, 95% CI= 7.43–125.47, P &amp;lt; 0.001 for CKD). The participants in the highest tertile of the VAI had a significantly higher prevalence of microalbuminuria and CKD than those in the lowest tertile of the VAI (OR = 2.63, 95% CI = 1.10–6.29, P = 0.03 for microalbuminuria; OR = 4.52, 95% CI = 2.09–9.81, P &amp;lt; 0.001 for CKD). Conclusion Higher METS-VF and VAI may be independently associated with a greater risk of microalbuminuria and CKD. The METS-VF and VAI can be useful clinical indicators for identifying microalbuminuria and CKD in the general population.

PurposeTo investigate the correlation between visceral obesity and pathogenesis of chronic kidney disease (CKD) among non-diabetic individuals, and to evaluate the potential of visceral adiposity index (VAI) as a predictor of CKD.Patients and MethodsFrom December 2017 to March 2018, 1877 non-diabetic participants (male n=699, female n=1208) in southern China were recruited for a cross-sectional survey. Males and females were divided into four groups according to gender-specific quartiles of VAI scores. A logistic regression model was established to analyze the correlation between visceral adiposity index and CKD.ResultsVisceral adiposity index was positively correlated with CKD and was negatively associated with estimated glomerular filtration rate (eGFR). Using group one as the control, odds ratios (ORs) were calculated to determine the risk of developing CKD as VAI increased (male: group four 2.73 [P<0.005]; female: Group three 1.76 [P<0.05], Group four 2.88 [P<0.005]). When related factors such as history of hypertension, smoking, alcohol use, and physical inactivity were normalized in the logistic model before calculation, ORs became 2.73 (male: P<0.05), and 2.18 (female: P<0.05), respectively. The results differed after normalizing further for systolic blood pressure (SBP), diastolic blood pressure (DBP), hypersensitive c-reactive protein (hsCRP), interleukin-6 (IL-6), homocysteine (Hcy), superoxide dismutase (SOD), and retinol-binding protein (RBP). There were no significant differences in ORs among the female groups.ConclusionVisceral adiposity index was significantly associated with CKD in non-diabetic individuals. It may be a good predictor of the pathogenesis of CKD and was dependent on hsCRP, IL-6, Hcy, SOD, RBP, and blood pressure levels in females and males with VAI scores of 1.41 and higher. Visceral adiposity index may be used to predict CKD in males with VAI less than 0.983.

The association between visceral adiposity index and chronic kidney disease in the elderly: A cross-sectional analysis of NHANES 2011–2018

Objective This study aims to investigate the prevalence of chronic kidney disease (CKD) and explore the associations of the Visceral Adiposity Index (VAI) and Body Roundness Index (BRI) with CKD risk in the Hakka population, while quantitatively assessing the mediating effects of blood pressure indicators. Methods Data for this study were obtained from a cross-sectional survey conducted in Bobai County, Guangxi, which included 8971 adult participants. Log-binomial regression, robust Poisson regression, and restricted cubic spline regression were used to evaluate the associations between the VAI/BRI and CKD risk. Mediation analysis was further conducted to assess the role of blood pressure parameters in these associations. Results The overall prevalence of CKD was 12.62% in the study population. In the fully adjusted multivariable model (Model 3), compared with the lowest quartiles (Q1, reference), the highest quartiles (Q4) of both VAI and BRI were significantly associated with increased risks of CKD, with prevalence ratios of 1.61 (95% CI: 1.32–1.98) and 1.26 (95% CI: 1.05–1.52), respectively. Restricted cubic spline analysis revealed nonlinear associations between VAI/BRI and CKD risk, with accelerated risk increments at higher levels of both indices. Mediation analysis revealed that blood pressure indicators significantly mediated the VAI/BRI-CKD relationships, with notably stronger effects observed for BRI (SBP: 42.69%; DBP: 51.16%; MAP: 53.38%) compared to VAI (SBP: 21.4%; DBP: 28.15%; MAP: 28.41%). Additionally, PP exhibited a significant mediating effect only in the BRI-CKD pathway (12.21, 95% CI: 7.28–20.70). Conclusion The VAI and BRI were independent risk factors for CKD in Hakka Biobank (HKB), with their associations with CKD are partially mediated by blood pressure. Given their ease of measurement and cost-effectiveness, VAI and BRI may serve as practical screening tools for identifying CKD high-risk individuals in community populations, thereby enabling early intervention and targeted prevention strategies of CKD.

AimTo validate the association between visceral obesity and pathogenesis of chronic kidney disease (CKD) among individuals aged 40 years and above, and the potential of visceral adiposity index (VAI) to predict CKD.MethodsThis study was based on a cross-sectional epidemiologic study in the People’s Republic of China. A total of 1,581 residents aged over 40 years were included and divided into four groups based on VAI quartile intervals, namely, Groups I, II, III, and IV (eg, Group I included patients with their VAIs in the lowest quartile). Logistic regression analysis was performed.ResultsVAI is positively correlated with the albumin-to-creatinine ratio and the prevalence of CKD (P<0.001), and is inversely related to estimated glomerular filtration rate (P<0.001). Using Group I as control, odds ratios (ORs) were calculated to quantify the risk of developing CKD as VAI increased (Group II 1.08 [P>0.05], Group III 1.57 [P<0.05], Group IV 2.31 [P<0.001]). Related factors like age and sex were normalized in the logistic model before calculation. ORs became 1.16 (P>0.05), 1.59 (P<0.05), and 2.14 (P<0.05), respectively, for each group after further normalization considering smoking, drinking, physical activity, education, and the history of hypertension, coronary heart disease, and diabetes. The same results were not observed after fasting blood glucose and blood pressure levels were included in the normalization. There was no significant difference in the ORs for different groups: 0.94 (P>0.05), 1.11 (P<0.05), and 1.68 (P>0.05), respectively.ConclusionVAI is highly correlated with the prevalence of CKD in the population aged 40 years and above. It can be used to predict the pathogenesis of CKD, which is dependent on fasting blood glucose and blood pressure levels.

Visceral Adiposity Index Is Inversely Associated with Renal Function in Normal-Weight Adults with Hypertension: The China H-Type Hypertension Registry Study.

Introduction: Obesity has been established as a significant risk factor for rapid kidney function decline (RKFD) and chronic kidney disease (CKD). However, the comparative prognostic value of various obesity-related indices in predicting RKFD and CKD remains inadequately elucidated. The objective of this study was to explore the correlations between ten obesity-related indices: body mass index (BMI), Chinese visceral adiposity index (CVAI), waist-to-height ratio, visceral adiposity index (VAI), body roundness index (BRI), a body shape index (ABSI), lipid accumulation product (LAP), waist triglyceride index (WTI), relative fat mass (RFM), and conicity index (C-index) and RKFD and CKD. Methods: This retrospective longitudinal cohort study leveraged data sourced from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression models with covariate adjustment were employed to assess independent associations between obesity-related indices and clinical outcomes. Restricted cubic spline (RCS) regression analyses were performed to characterize potential nonlinear relationships. Predictive performance was quantified through receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) comparisons. Results: A total of 1,620 participants were enrolled in this study. Among them, 109 participants developed RKFD, and 60 progressed to CKD. Adjusted logistic regression revealed significant positive associations between CVAI, VAI, LAP, WTI, and RKFD risk, while BRI and C-index demonstrated per standard deviation increases associated with CKD progression. RCS curve analysis demonstrated that CVAI and LAP exhibited a nonlinear relationship with the risk of RKFD, while VAI and WTI had a linear relationship. Moreover, the C-index had a nonlinear relationship with the risk of CKD, whereas BRI had a linear relationship. ROC analysis revealed WTI as the superior RKFD predictor and ABSI as the optimal CKD progression indicator among the evaluated obesity-related indices. Conclusion: This study comprehensively investigated the associations between ten obesity-related indices and both RKFD and CKD. Our findings indicated that CVAI, VAI, LAP, and WTI were associated with RKFD, with WTI exhibiting the highest predictive value. Furthermore, BRI and C-index were associated with CKD, with ABSI demonstrating the highest predictive value for the progression to CKD.

PurposeMetabolic disorders are closely related to the occurrence and development of chronic kidney disease (CKD). We explored the prospective association between the Metabolic Score for Visceral Fat (METS-VF) and CKD in a 5-year follow-up study.Patients and MethodsIn this cohort study, 631 adults not suffering from CKD from Wanzhai Town, in China in 2012 were included at baseline and followed up in 2017 and 2018. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between METS-VF and CKD risk. Area under the receiver operating characteristic curve (AUC) analyses were used to evaluate the ability of METS-VF, waist-to-height ratio (WhtR), visceral adiposity index (VAI), homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI) to predict CKD risk.ResultsWe identified 103 CKD cases during follow-up. After adjustment for confounding factors, comparing the lowest quartile of METS-VF, the OR (95% CI) of CKD risk in the highest quartile was 3.04 (1.39–6.64). The per Standard deviation (SD) increase in METS-VF was positively correlated with CKD risk. The AUC of METS-VF for predicting CKD risk was, in general, higher than that for WhtR, VAI, HOMA-IR, and BMI.ConclusionMETS-VF may be an indicator for predicting CKD risk.