Visceral Adiposity Index Is Associated With the Development of Increased Urinary Albumin Excretion and Chronic Kidney Disease: A Population-Based Study

Background: In recent years, the impact of visceral fat accumulation on renal damage has garnered significant attention. However, whether visceral fat accumulation contributes to the incidence of both albuminuria and chronic kidney disease (CKD) is still uncertain. Our objective is to look into the possible correlation between visceral adiposity accumulation and incident increased urinary albumin excretion and CKD. Methods: We analyzed data from a cohort of 9916 subjects aged 40 years and above. As an innovative and convenient biomarker of visceral adiposity distribution, visceral adiposity index (VAI) was calculated in accordance with a gender-specific equation using measurement of blood lipids and anthropometric parameters of obesity. Albuminuria was determined by urine albumin-to-creatinine ratio (UACR) >= 30 mg/g. CKD was determined by establishment of either of the following: (1) estimated glomerular filtration rate (eGFR) 60 mL/min per 1.73 m(2) or less; (2) UACR >= 30 mg/g. Results: During an average follow-up period of 3.6 +/- 0.7 years, 245 (4.7%) subjects developed albuminuria and 332 (6.3%) participants developed CKD. Incidence of albuminuria and CKD had a tendency to advance along with ascending VAI levels in both genders. According to multiple stepwise linear regression analysis, gamma-glutamyltransferase (gamma-GGT), fasting insulin, fasting plasma glucose (FPG), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) were independent determinants for VAI. Multivariate-adjusted hazard ratios (HRs) of albuminuria with 95% confidence intervals (CIs) in Cox regression analysis were 1 (reference), 0.82 (0.53-1.29), 1.50 (1.01-2.23), and 1.52 (1.02-2.26) in ascending quartiles of VAI. Similarly, the HRs with 95% CI of CKD in ascending quartiles of VAI were 1 (reference), 0.96 (0.66-1.41), 1.51 (1.07-2.15), and 1.56 (1.10-2.20). For subgroup analyses, VAI significantly correlated with risk of both albuminuria and CKD in older subjects (age >= 58 years), nondiabetes subjects, and non-ASCVD subjects (all p < 0.05). Conclusions: The greater deposition of visceral fat assessed by VAI is independently associated with risk of increased urinary albumin excretion and CKD in middle-aged and aged Chinese.