Zhongguo gonggong weisheng (Jun 2024)
Association between kidney function trajectories and cardiovascular disease incidence among rural Uyghur residents in Xinjiang: a prospective cohort study
Abstract
ObjectiveTo understand the relationship between kidney function trajectories and cardiovascular disease (CVD) incidence among adult rural Uyghurs in Xinjiang Uyghur Autonomous Region (Xinjiang), and to provide a reference for early detection and prevention of CVD in the population. MethodsA total of 6 417 rural Uyghur residents aged ≥ 18 years in Regiment 51, Third Division of the Xinjiang Production and Construction Corps were recruited for a baseline survey in September 2016 using typical sampling. Follow-up surveys were conducted in April 2019, June 2020, July 2021 and June 2022 among 5 585 non-frequent migrants with complete basic information and no chronic kidney disease or CVD at baseline. Kidney function trajectories were constructed using a group-based trajectory model to determine the number and trend of trajectories. The log-rank test was used to compare the cumulative incidence of CVD among residents with different renal function trajectories. The Cox proportional hazards regression model was used to analyze the relationship between renal function trajectory groups and CVD incidence, and subgroup analysis and sensitivity analysis were used to validate the results. ResultsAs of June 2022, 414 (7.41%) of the 5 585 participants were lost to follow-up; after excluding 429 participants with < 3 serum creatinine measurements, a total of 4 742 participants were finally included in the analysis, with a total follow-up of 27 018.48 person-years and a mean follow-up of 5.70 ± 0.96 person-years. A total of 563 cases of CVD were observed during the follow-up period, with a cumulative incidence of 11.87%. Based on the group-based trajectory model analysis, the 4 742 participants were classified into four groups with different kidney function trajectories: high-level stable progression of estimated glomerular filtration rate (eGFR) group (2 128 individuals, 44.88% of the participants), gradually increasing eGFR group (1207, 25.45%), gradually decreasing eGFR group (988, 20.84%), and rapidly decreasing eGFR group (419, 8.83%), respectively; the cumulative incidence of CVD observed at follow-up in these groups was 232, 87, 156, and 88, with significantly different cumulative incidence rates of 10.90%, 7.21%, 15.79%, and 21.00% (χ2 = 74.882, P < 0.001). After adjustment for sex, age, smoking status, alcohol consumption, hypertension, diabetes, overweight/obesity, dyslipidaemia/hypertension/diabetes/CVD/stroke, the Cox proportional hazards regression model analysis showed that, compared with those in the high stable eGFR group, participants in the gradually increasing eGFR group had a reduced risk of CVD incidence (hazard ratio [HR] = 0.766, 95% confidence interval [95%CI]: 0.598 – 0.983), whereas participants in the gradually decreasing eGFR group and the rapidly decreasing eGFR group had an increased risk of CVD incidence, with HR (95%CI) of 1.297 (1.059 – 1.590) and 1.865 (1.458 – 2.385), respectively; further subgroup analysis revealed HR (95%CI) of 2.577 (1.698 – 3.909), 1.629 (1.196 – 2.220), 1.729 (1.078 – 2.774), and 1.867 (1.399 – 2.492) for participants who were male, female, < 45 years of age, and ≥ 45 years of age in the rapidly declining eGFR group, respectively. Sensitivity analysis results after sequential exclusion of those with hypertension, diabetes and dyslipidaemia at baseline showed increased risks of CVD incidence in participants in the rapidly declining eGFR group, with HR (95%CI) of 1.638 (1.157 – 2.319), 1.854 (1.426 – 2.410) and 1.667 (1.227 – 2.264) compared with those in the high-grade stable eGFR group, indicating good robustness of the results. ConclusionBoth increasing and decreasing eGFR trajectories are associated with the risk of CVD incidence among rural Uyghur residents in Xinjiang; those with increasing eGFR have a decreased risk of CVD incidence, whereas those with decreasing eGFR have an increased risk of CVD incidence.
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