Associations between visceral adiposity index and incident nephropathy outcomes in diabetic patients: Insights from the ACCORD trial

Abstract Aims Visceral adiposity index (VAI) was a reliable marker for visceral adiposity accumulation and dysfunction. The association between VAI and nephropathy outcomes remains uncertain in patients with type 2 diabetes (T2DM). We aimed to evaluate the longitudinal relationships between VAI and incident nephropathy outcomes in T2DM patients. Materials and Methods Ten thousand one hundred and thirty two participants with T2DM from the ACCORD trial were included in the present study. Cumulative average VAI based on VAI measurements at baseline and follow‐up was used to represent long‐term VAI status. The primary outcome was the incident composite nephropathy outcome defined as: (1) serum creatinine doubling or >20 ml/min decrease in eGFR; or (2) development of macro‐albuminuria; or (3) renal failure or end stage kidney disease (dialysis) or serum creatinine >3.3 mg/dl. Results During 26,168 person‐years follow‐up duration, 6094 (60.1%) participants developed the incident composite nephropathy outcome. When assessing cumulative average VAI as quartiles, compared with those in the 1–2 quartiles (<2.6), a significantly higher risk of incident composite nephropathy outcomes was observed among participants in the 3–4 quartiles (≥2.6, adjusted HR: 1.09, 95% CI: 1.01, 1.18). Moreover, the positive association was consistent in participants with or without single abnormal VAI components, including general obesity, abdominal obesity, elevated triglycerides, and low high‐density lipoprotein cholesterol, or with different numbers of abnormal VAI components. Additionally, the positive association was stronger in participants with cumulative average systolic blood pressure <130 mmHg (vs. ≥130 mmHg; p ‐interaction < 0.001). Conclusions In T2DM patients, higher cumulative average VAI was associated with a higher risk of incident composite nephropathy outcomes. Clinical Trial Registration clinicaltrials.gov , identifier: NCT00000620