PMID- 38374967 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240221 IS - 2589-5370 (Electronic) IS - 2589-5370 (Linking) VI - 69 DP - 2024 Mar TI - Dose-response association of diabetic kidney disease with routine clinical parameters in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. PG - 102482 LID - 10.1016/j.eclinm.2024.102482 [doi] LID - 102482 AB - BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease and is associated with high mortality rates. The influence of routine clinical parameters on DKD onset in patients with type 2 diabetes mellitus (T2DM) remains uncertain. METHODS: In this systematic review and meta-analysis, we searched multiple databases, including PubMed, Embase, Scopus, Web of Science, and Cochrane Library, for studies published from each database inception until January 11, 2024. We included cohort studies examining the association between DKD onset and various clinical parameters, including body mass index (BMI), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and serum uric acid (UA). Random-effect dose-response meta-analyses utilizing one-stage and/or cubic spline models, were used to estimate correlation strength. This study is registered in PROSPERO (CRD42022326148). FINDINGS: This analysis of 46 studies involving 317,502 patients found that in patients with T2DM, the risk of DKD onset increased by 3% per 1 kg/m(2) increase in BMI (relative risk (RR) = 1.03, confidence interval (CI) [1.01-1.04], I(2) = 70.07%; GRADE, moderate); a 12% increased risk of DKD onset for every 1% increase in HbA1c (RR = 1.12, CI [1.07-1.17], I(2) = 94.94%; GRADE, moderate); a 6% increased risk of DKD onset for every 5 mmHg increase in SBP (RR = 1.06. CI [1.03-1.09], I(2) = 85.41%; GRADE, moderate); a 2% increased risk of DKD onset per 10 mg/dL increase in TG (RR = 1.02, CI [1.01-1.03], I(2) = 78.45%; GRADE, low); an 6% decreased risk of DKD onset per 10 mg/dL increase in HDL (RR = 0.94, CI [0.92-0.96], I(2) = 0.33%; GRADE, high), and a 11% increased risk for each 1 mg/dL increase in UA (RR = 1.11, CI [1.05-1.17], I(2) = 79.46%; GRADE, moderate). Subgroup analysis revealed a likely higher risk association of clinical parameters (BMI, HbA1c, LDL, and UA) in patients with T2DM for less than 10 years. INTERPRETATION: BMI, HbA1c, SBP, TG, HDL and UA are potential predictors of DKD onset in patients with T2DM. Given high heterogeneity between included studies, our findings should be interpreted with caution, but they suggest monitoring of these clinical parameters to identify individuals who may be at risk of developing DKD. FUNDING: Shenzhen Science and Innovation Fund, the Hong Kong Research Grants Council, and the HKU Seed Funds, and Scientific and technological innovation project of China Academy of Chinese Medical Sciences. CI - (c) 2024 The Author(s). FAU - Guo, Jianbo AU - Guo J AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. AD - Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. FAU - Liu, Chen AU - Liu C AD - Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China. FAU - Wang, Yifan AU - Wang Y AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Shao, Baoyi AU - Shao B AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Fong, Tung Leong AU - Fong TL AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Lau, Ngai Chung AU - Lau NC AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Zhang, Hui AU - Zhang H AD - Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. FAU - Li, Haidi AU - Li H AD - School of Pharmacy, Anhui Medical University, Hefei, China. FAU - Wang, Jianan AU - Wang J AD - School of Pharmacy, Anhui Medical University, Hefei, China. FAU - Lu, Xinyu AU - Lu X AD - Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. FAU - Wang, Anqi AU - Wang A AD - Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China. FAU - Leung, Cheuk Lung AU - Leung CL AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Chia, Xin Wei AU - Chia XW AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Li, Fei AU - Li F AD - Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China. FAU - Meng, Xiaoming AU - Meng X AD - School of Pharmacy, Anhui Medical University, Hefei, China. FAU - He, Qingyong AU - He Q AD - Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. FAU - Chen, Haiyong AU - Chen H AD - School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. AD - Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. LA - eng PT - Journal Article DEP - 20240213 PL - England TA - EClinicalMedicine JT - EClinicalMedicine JID - 101733727 PMC - PMC10875261 OTO - NOTNLM OT - Clinical parameters OT - Diabetic nephropathy OT - Dose-response meta-analysis OT - Type 2 diabetes mellitus COIS- All authors declare no competing interests. EDAT- 2024/02/20 11:51 MHDA- 2024/02/20 11:52 PMCR- 2024/02/13 CRDT- 2024/02/20 03:37 PHST- 2023/11/08 00:00 [received] PHST- 2024/01/24 00:00 [revised] PHST- 2024/01/25 00:00 [accepted] PHST- 2024/02/20 11:52 [medline] PHST- 2024/02/20 11:51 [pubmed] PHST- 2024/02/20 03:37 [entrez] PHST- 2024/02/13 00:00 [pmc-release] AID - S2589-5370(24)00061-0 [pii] AID - 102482 [pii] AID - 10.1016/j.eclinm.2024.102482 [doi] PST - epublish SO - EClinicalMedicine. 2024 Feb 13;69:102482. doi: 10.1016/j.eclinm.2024.102482. eCollection 2024 Mar.