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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). Addit ionally, 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. © 2025 Elsevier Inc.
Authors : Moh M.C.; Low S.; Pek S.L.T.; Liu J.-J.; Ang K.; Tang W.E.; Lim Z.; Subramaniam T.; Sum C.F.; Lim S.C.
Source : Elsevier Inc.
Article Information
| Year | 2025 |
| Type | Article |
| DOI | 10.1016/j.jdiacomp.2025.108953 |
| ISSN | 10568727 |
| Volume | 39 |
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