Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus

Abstract

Background Intrinsic capacity (IC) is a novel concept focusing on normal and healthy aging. The effect of IC on the risk of chronic kidney disease (CKD) according to KDIGO category in older type 2 diabetes mellitus (T2DM) patients has rarely been studied. We investigated whether a decline in IC is associated with the risk of CKD according to KDIGO 2012 categories. Methods This is a cross-sectional study. The exposure variables (IC score and body mass index) and outcome variable (KDIGO categories of the risk of CKD) were collected at the same timepoint. A total of 2482 older subjects with T2DM managed through a disease care program were enrolled. The five domains of IC, namely locomotion, cognition, vitality, sensory, and psychological capacity were assessed. Based on these domains, the IC composite score was calculated. CKD risk was classified according to the KDIGO 2012 CKD definition. Univariate and multivariate analyses were used to assess the association between IC score and KDIGO categories of risk of CKD. Results The KDIGO CKD risk category increased in parallel with IC score (p for trend < 0.0001). In multivariate analysis, compared to those with an IC score 0, the odds ratio of having a KDIGO moderately increased to very high risk category of CKD was 1.76 (1.31–2.37) times higher for those with an IC score of 2–5. Furthermore, an increased IC score was associated with a higher prevalence of moderate and severe obesity. Moreover, there was a synergistic interaction between IC score and obesity on the KDIGO moderately increased to very high risk category of CKD (synergy index = 1.683; 95% CI 0.630–3.628), and the proportion of the KDIGO moderately increased to very high risk category of CKD caused by this interaction was 25.6% (attributable proportion of interaction = 0.256). Conclusions Our findings indicate that IC score may be closely related to the KDIGO moderately increased to very high risk category of CKD. In addition, there may be a synergistic interaction between IC score and obesity, and this synergistic interaction may increase the KDIGO CKD risk stage.

Factors associated with the intrinsic capacity in older adults: A scoping review

“…Only one study (Lin et al., 2022) showed that older adults with worse IC were less likely to be smokers than those with better IC. However, no association was found in the other two studies (Jia et al., 2023; Tang et al., 2023).…”

“…19 of the 29 studies looked at the effect of age on the IC of older adults, involving 95,732 participants. Eighteen studies (Beard et al., 2019; Beard et al., 2022; Campbell et al., 2022; Jia et al., 2023; Leung et al., 2022; Lin et al., 2022; Lu et al., 2021; Ma et al., 2021a; Muneera et al., 2022; Prince et al., 2021; Tang et al., 2023; Wu et al., 2022; Yu et al., 2021; Yu et al., 2022a; Yu et al., 2022b; Yu et al., 2022c; Yu et al., 2023; Zhao et al., 2021) discovered a significant association between age and IC of older adults, indicating that the younger old adults were likely to have a better IC. And only one study (Ma et al., 2021c) showed no differences between age and IC of older adults.…”

“…Sixteen studies with 89,332 participants investigated the relationship between sex and IC of older adults. Thirteen studies (Beard et al., 2019; Beard et al., 2022; Campbell et al., 2022; Lin et al., 2022; Lu et al., 2021; Muneera et al., 2022; Prince et al., 2021; Tang et al., 2023; Yu et al., 2021; Yu et al., 2022b; Yu et al., 2023; Yu, Leung, et al., 2022; Zhao et al., 2021) found a significant association between sex and IC of older adults, with older females being more likely to have poorer IC. However, the other three studies (Jia et al., 2023; Wu et al., 2022; Yu et al., 2022a) did not observe such findings.…”

“…Three studies (Leung et al., 2022;Prince et al., 2021; Tang et al., 2023) examined the relationship between hypertension and IC of older adults in 19,817 participants, indicating that hypertension was relevant to the decline of IC.…”

“…The correlation between diabetes and IC was investigated in two studies (Prince et al., 2021; Tang et al., 2023) involving 19,513 participants, and it was discovered that diabetes had a significant impact on the IC of older adults. The other 29 relevant factors were reported by only one or two studies.…”