Association of Decreased Kidney Function with Hyperuricemia in Different Subtypes of Prediabetes and Diabetes in Chinese Rural Residents: A Community-Based Cross-Sectional Study

Abstract

Background: We aimed to explore the risk factors and differences in decreased kidney function across the different subtypes of patients with prediabetes and diabetes among rural Chinese residents. Methods: A total of 7581 residents of a community in Songjiang District, Shanghai, who were older than 40 years, were enrolled in this cross-sectional survey. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and eGFR <60 mL/min/1.73 m² was defined as decreased kidney function. Subjects were divided into normal glucose tolerance (NGT), prediabetes, and diabetes groups according to a 75-g oral glucose tolerance test (OGTT) or self-reported diagnosis of diabetes. Results: Of the 7581 subjects, 3578 had NGT, 1581 had diabetes and 2422 had prediabetes. In our study, 2.9% (47/1581) of diabetic patients and 2.4% (60/2422) of prediabetes patients in our study had decreased kidney function. The eGFR in the diabetes (94.1 ± 14.4 mL/min/1.73 m²), combined glucose intolerance (CGI) (94.1 ± 13 mL/min/1.73 m²) and impaired glucose tolerance (IGT) (93.1 ± 13.7 mL/min/1.73 m²) groups was significantly lower than that in the NGT (95.7 ± 12.3 mL/min/1.73 m²) and impaired fasting glucose (IFG) (95.6 ± 12.4 mL/min/1.73 m²) groups (p < 0.001). Older age, age ≥60 years, female sex, and higher uric acid (UA) levels were common risk factors for decreased kidney function in the prediabetes and diabetes groups. Elevated levels of high-density lipoprotein cholesterol (HDL-C) were identified as a risk factor, while body mass index (BMI) ≥24 kg/m² was a protective factor against decreased kidney function in the prediabetes group. The area under the receiver operating characteristic (ROC) curve (AUC) of UA for predicting decreased kidney function was 0.7935 (95% Confidence interval (CI) 0.7058, 0.8329) in patients with diabetes and 0.7694 (95% CI 0.7058, 0.8329) in patients with prediabetes. Conclusions: The prevalence of decreased kidney function in patients with different abnormal glycemic statuses was similar, whereas there were significant differences in eGFR levels among the different subtypes of prediabetes and diabetes. Older age, age ≥60 years, female sex, and hyperuricemia were common risk factors for decreased kidney function in prediabetes and diabetes patients. Reducing UA levels in prediabetes and diabetes patients may protect kidney function among rural Chinese residents.