{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:34:57Z","timestamp":1791812097464,"version":"4.3.4"},"reference-count":49,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,7,27]],"date-time":"2025-07-27T00:00:00Z","timestamp":1753574400000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC3605500"],"award-info":[{"award-number":["2023YFC3605500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Research Center for Geriatric Diseases Open Project","award":["NCRCG-PLAGH-2024017"],"award-info":[{"award-number":["NCRCG-PLAGH-2024017"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2025,7,12]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Limited research has focused on the prospective influence of insulin resistance (IR) on new-onset chronic kidney disease (CKD) in healthy screening populations. Therefore, we aimed to investigate how IR, assessed via the estimated glucose disposal rate (eGDR), and metabolism-related comorbidities influence new-onset CKD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>This two-stage retrospective cohort study (cross-sectional and longitudinal analyses) used data from health check-up participants at the Chinese People\u2019s Liberation Army General Hospital (2009\u20132021). The cross-sectional analysis included 83\u2009346 participants with or without CKD; the longitudinal analyses included 13\u2009738 participants without prior CKD who visited the hospital at least two times. The cross-sectional phase of this study analyzed the relationship between IR and CKD; the longitudinal phase analyzed the relationship between IR and new-onset CKD. The mediating role of metabolism-related comorbidities was also explored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the cross-sectional analysis, 6.77% (n=5643) of patients had prior CKD. The eGDR was significantly higher in the non-CKD group than in the CKD group (9.16\u00b12.11 vs 7.19\u00b12.32, p&lt;0.001). Higher eGDR was associated with lower CKD prevalence (OR: 0.91, 95% CI: 0.89 to 0.93, P for trend&lt;0.001). In the cohort analysis, the average time to trigger endpoint events was 2.95\u00b12.02 years, with 403 (2.93%) new-onset CKD cases reported. A linear correlation was observed between eGDR and new-onset CKD (p&lt;0.001), with higher eGDR linked to reduced CKD risk (HR: 0.88, 95%\u2009CI: 0.82 to 0.96, P for trend=0.002). Mediation analysis revealed significant indirect effects of diabetes mellitus (17.1%), systolic blood pressure (22.0%), glycated hemoglobin (11.1%), and brachial\u2013ankle pulse wave velocity (9.7%) (all p&lt;0.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>IR is independently linked to new-onset CKD, with blood glucose, blood pressure, and arterial stiffness mediating this relationship. These findings underscore the importance of managing IR and metabolic comorbidities to prevent CKD onset in at-risk populations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2025-005137","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T01:40:18Z","timestamp":1753666818000},"page":"e005137","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Influence of metabolism-related comorbidities and insulin resistance on new onset of chronic kidney disease in a health check-up population: a two-stage retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5075-401X","authenticated-orcid":false,"given":"Guang","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-5163","authenticated-orcid":false,"given":"Bokai","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingli","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yansong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Health Management Institute, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6711-5759","authenticated-orcid":false,"given":"Jiahui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nephrology, General Hospital of the People\u2019s Liberation Army, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,27]]},"reference":[{"key":"2025072718400999000_13.4.e005137.1","doi-asserted-by":"crossref","DOI":"10.1080\/0886022X.2024.2403645","article-title":"Epidemiological analysis of chronic kidney disease from 1990 to 2019 and predictions to 2030 by Bayesian age-period-cohort analysis","volume":"46","author":"Dong","year":"2024","journal-title":"Ren Fail"},{"key":"2025072718400999000_13.4.e005137.2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.kisu.2024.01.005","article-title":"Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)","volume":"13","author":"Prikhodina","year":"2024","journal-title":"Kidney Int Suppl (2011)"},{"key":"2025072718400999000_13.4.e005137.3","doi-asserted-by":"crossref","DOI":"10.1093\/ckj\/sfae235","article-title":"Aging and chronic kidney disease: epidemiology, therapy, management and the role of immunity","volume":"17","author":"Tang","year":"2024","journal-title":"Clin Kidney J"},{"key":"2025072718400999000_13.4.e005137.4","doi-asserted-by":"crossref","DOI":"10.3390\/nu14183787","article-title":"Lifestyle-Related Risk Factors for the Incidence and Progression of Chronic Kidney Disease in the Healthy Young and Middle-Aged Population","volume":"14","author":"Kuma","year":"2022","journal-title":"Nutrients"},{"key":"2025072718400999000_13.4.e005137.5","article-title":"Chronic Kidney Disease Interplay with Comorbidities and Carbohydrate Metabolism: A Review","volume":"14","author":"Kushwaha","year":"2023","journal-title":"Life (Basel)"},{"key":"2025072718400999000_13.4.e005137.6","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-0369"},{"key":"2025072718400999000_13.4.e005137.7","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.05230513"},{"key":"2025072718400999000_13.4.e005137.8","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08070910"},{"key":"2025072718400999000_13.4.e005137.9","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2013.00296"},{"key":"2025072718400999000_13.4.e005137.10","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2573"},{"key":"2025072718400999000_13.4.e005137.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-023-01791-x","article-title":"Estimated glucose disposal rate is associated with retinopathy and kidney disease in young people with type 1 diabetes: a nationwide observational study","volume":"22","author":"Linn","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-021-01936-3","article-title":"Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study","volume":"19","author":"Penno","year":"2021","journal-title":"BMC Med"},{"key":"2025072718400999000_13.4.e005137.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-022-02817-0","article-title":"Impact of estimated glucose disposal rate for identifying prevalent ischemic heart disease: findings from a cross-sectional study","volume":"22","author":"Xuan","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"2025072718400999000_13.4.e005137.14","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jacasi.2023.02.001","article-title":"Combined Evaluation of Arterial Stiffness and Blood Pressure Promotes Risk Stratification of Peripheral Arterial Disease","volume":"3","author":"Wu","year":"2023","journal-title":"JACC Asia"},{"key":"2025072718400999000_13.4.e005137.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-024-03582-x","article-title":"Estimated glucose disposal rate for predicting cardiovascular events and mortality in patients with non-diabetic chronic kidney disease: a prospective cohort study","volume":"22","author":"Peng","year":"2024","journal-title":"BMC Med"},{"key":"2025072718400999000_13.4.e005137.16","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1001\/jamainternmed.2022.6817","article-title":"Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance","volume":"183","author":"Wang","year":"2023","journal-title":"JAMA Intern Med"},{"key":"2025072718400999000_13.4.e005137.17","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2022.03.014"},{"key":"2025072718400999000_13.4.e005137.18","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2014.10.019"},{"key":"2025072718400999000_13.4.e005137.19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/nep.13147","article-title":"Insulin resistance in chronic kidney disease","volume":"22 Suppl 4","author":"Xu","year":"2017","journal-title":"Nephrology (Carlton)"},{"key":"2025072718400999000_13.4.e005137.20","doi-asserted-by":"crossref","first-page":"E87","DOI":"10.1152\/ajpendo.1991.261.1.E87","article-title":"Muscle insulin resistance in uremic humans: glucose transport, glucose transporters, and insulin receptors","volume":"261","author":"Friedman","year":"1991","journal-title":"American Journal of Physiology-Endocrinology and Metabolism"},{"key":"2025072718400999000_13.4.e005137.21","doi-asserted-by":"publisher","DOI":"10.1172\/JCI110067"},{"key":"2025072718400999000_13.4.e005137.22","doi-asserted-by":"crossref","first-page":"E1108","DOI":"10.1152\/ajpendo.00070.2018","article-title":"Insulin resistance is a significant determinant of sarcopenia in advanced kidney disease","volume":"315","author":"Deger","year":"2018","journal-title":"American Journal of Physiology-Endocrinology and Metabolism"},{"key":"2025072718400999000_13.4.e005137.23","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.3390\/ijms20112751","article-title":"Mitochondrial Activity and Skeletal Muscle Insulin Resistance in Kidney Disease","volume":"20","author":"Carr\u00e9","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2025072718400999000_13.4.e005137.24","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.3390\/ijms25052739","article-title":"Effects of Alterations in Acid-Base Effects on Insulin Signaling","volume":"25","author":"Frassetto","year":"2024","journal-title":"Int J Mol Sci"},{"key":"2025072718400999000_13.4.e005137.25","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-0490"},{"key":"2025072718400999000_13.4.e005137.26","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00394.2016"},{"key":"2025072718400999000_13.4.e005137.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-024-02256-5","article-title":"Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases among individuals without diabetes: findings from a nationwide, population based, prospective cohort study","volume":"23","author":"Zhang","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2019.02.023"},{"key":"2025072718400999000_13.4.e005137.29","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.cmet.2022.12.002","article-title":"Cardiometabolic health improvements upon dietary intervention are driven by tissue-specific insulin resistance phenotype: A precision nutrition trial","volume":"35","author":"Trouwborst","year":"2023","journal-title":"Cell Metab"},{"key":"2025072718400999000_13.4.e005137.30","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/9270768","article-title":"Assessment of Insulin Resistance in Subjects with Normal Glucose Tolerance, Hyperinsulinemia with Normal Blood Glucose Tolerance, Impaired Glucose Tolerance, and Newly Diagnosed Type 2 Diabetes (Prediabetes Insulin Resistance Research)","volume":"2016","author":"Yang","year":"2016","journal-title":"J Diabetes Res"},{"key":"2025072718400999000_13.4.e005137.31","doi-asserted-by":"crossref","first-page":"18472","DOI":"10.1038\/s41598-024-69338-y","article-title":"Association between insulin resistance and vascular damage in an adult population in China: a cross-sectional study","volume":"14","author":"Ma","year":"2024","journal-title":"Sci Rep"},{"key":"2025072718400999000_13.4.e005137.32","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2023.1175988","article-title":"Association between MetS-IR and prediabetes risk and sex differences: a cohort study based on the Chinese population","volume":"14","author":"Xie","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2025072718400999000_13.4.e005137.33","doi-asserted-by":"crossref","first-page":"4930355","DOI":"10.1155\/2022\/4930355","article-title":"Dose-Response Associations of Metabolic Score for Insulin Resistance Index with Nonalcoholic Fatty Liver Disease among a Nonobese Chinese Population: Retrospective Evidence from a Population-Based Cohort Study","volume":"2022","author":"Cai","year":"2022","journal-title":"Dis Markers"},{"key":"2025072718400999000_13.4.e005137.34","doi-asserted-by":"crossref","unstructured":"Zhu Q , Chen Y , Cai X , et al . n.d. The non-linear relationship between triglyceride-glucose index and risk of chronic kidney disease in hypertensive patients with abnormal glucose metabolism: A cohort study. Front Med 9:1018083. doi:10.3389\/fmed.2022.1018083","DOI":"10.3389\/fmed.2022.1018083"},{"key":"2025072718400999000_13.4.e005137.35","doi-asserted-by":"crossref","DOI":"10.1186\/s13098-024-01408-7","article-title":"The U-shape relationship between insulin resistance-related indexes and chronic kidney disease: a retrospective cohort study from National Health and Nutrition Examination Survey 2007-2016","volume":"16","author":"Shen","year":"2024","journal-title":"Diabetol Metab Syndr"},{"key":"2025072718400999000_13.4.e005137.36","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001186"},{"key":"2025072718400999000_13.4.e005137.37","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1186\/s12933-024-02352-6","article-title":"Association between the triglyceride glucose-body mass index and future cardiovascular disease risk in a population with Cardiovascular-Kidney-Metabolic syndrome stage 0\u20133: a nationwide prospective cohort study","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.38","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2014.29"},{"key":"2025072718400999000_13.4.e005137.39","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-018-0692-1","article-title":"Association between triglyceride glucose index and arterial stiffness in Korean adults","volume":"17","author":"Lee","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.40","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jacasi.2023.10.010","article-title":"Causal Association of Arterial Stiffness With the Risk of Chronic Kidney Disease","volume":"4","author":"Tian","year":"2024","journal-title":"JACC Asia"},{"key":"2025072718400999000_13.4.e005137.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-019-0898-x","article-title":"Association between macro- and microvascular damage and the triglyceride glucose index in community-dwelling elderly individuals: the Northern Shanghai Study","volume":"18","author":"Zhao","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.42","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-023-01937-x","article-title":"The cardio-renal-metabolic connection: a review of the evidence","volume":"22","author":"Marassi","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"2025072718400999000_13.4.e005137.43","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14829"},{"key":"2025072718400999000_13.4.e005137.44","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.121.17981"},{"key":"2025072718400999000_13.4.e005137.45","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13649","article-title":"Association of metabolic syndrome and chronic kidney disease","volume":"25","author":"Scurt","year":"2024","journal-title":"Obes Rev"},{"key":"2025072718400999000_13.4.e005137.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.07.012"},{"key":"2025072718400999000_13.4.e005137.47","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2009010074"},{"key":"2025072718400999000_13.4.e005137.48","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.3390\/jcm13051334","article-title":"Deterioration of Kidney Function Is Affected by Central Arterial Stiffness in Late Life","volume":"13","author":"Tap","year":"2024","journal-title":"J Clin Med"},{"key":"2025072718400999000_13.4.e005137.49","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11111016"}],"container-title":["BMJ Open Diabetes Research &amp; Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjdrc-2025-005137","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T01:40:25Z","timestamp":1753666825000},"score":1,"resource":{"primary":{"URL":"https:\/\/drc.bmj.com\/lookup\/doi\/10.1136\/bmjdrc-2025-005137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,7,27]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjdrc-2025-005137"],"URL":"https:\/\/doi.org\/10.1136\/bmjdrc-2025-005137","relation":{},"ISSN":["2052-4897"],"issn-type":[{"value":"2052-4897","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}