Abstract
AIM: To investigate the association between longitudinal changing patterns of fasting plasma glucose (FPG), and kidney function change in the general population. METHODS: We conducted a retrospective, longitudinal cohort study of a health examination center database in China. Subjects who had at least three visits from 2011 to 2018 with baseline eGFR ≥60 mL/min/1.73 m(2) were enrolled. The FPG trajectories were identified by group-based trajectory modeling (GBTM). We examined the association of eGFR slopes and FPG trajectories by Cox analysis. RESULTS: Totally, 8114 participants were identified. Three heterogeneous FBP trajectories were detected by GBTM as low-stable group (n=7294), moderate-stable group (n=657) and high-stable group (n=163). The high-stable group had lower baseline eGFR, a higher percentage of fast eGFR slope, lower HDL-c, higher LDL-c, higher cholesterol, and higher Lg(triglyceride). Cox analysis showed that the high-stable trajectory was a risk factor for fast eGFR decline (for eGFR slope <-4 mL/min per 1.73 m(2) per year, adjusted HR [95% CI] 1.544 [0.876, 2.722]; for eGFR slope <-5 mL/min per 1.73 m(2) per year, adjusted HR [95% CI] 2.117[1.100, 4.075]). Further, we analyzed a subgroup in which participants' long-term FPG was normal. We divided this subgroup into four trajectories by GBTM, and Cox analysis showed that after adjustment for other potential confounding factors, the high-stable trajectory was an independent risk factor for fast eGFR slope (for eGFR slope <-4 mL/min per 1.73 m(2) per year, adjusted HR [95% CI] HR 1.640[1.050, 2.561]; for eGFR slope <-5 mL/min per 1.73 m(2) per year, adjusted HR [95% CI] 1.818[1.018, 3.248]) in subgroup. CONCLUSION: We found that discrete FPG trajectories were significantly associated with risk of fast eGFR slope in individuals and those with long-term normal FPG. These observations suggest the importance of early prevention of CKD among individuals who are high-glycemic and normoglycemic.