Association between fibroblast growth factor 21 and chronic kidney disease in individuals with prediabetes： a prospective cohort study

Huang Chulin; Lin Diaozhu; You Lili; Feng Wanting; Ren Meng; Yan Li; Sun Kan

doi:10.13406/j.cnki.cyxb.003978

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Association between fibroblast growth factor 21 and chronic kidney disease in individuals with prediabetes： a prospective cohort study

Endocrine regulation and metabolic diseases | 更新时间：2025-11-20

- Association between fibroblast growth factor 21 and chronic kidney disease in individuals with prediabetes： a prospective cohort study
- Journal of Chongqing Medical University Vol. 50, Issue 11, Pages: 1493-1499(2025)
- 作者机构：
  
  中山大学孙逸仙纪念医院内分泌科，广州 510120
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.003978
  CLC： R587.2
- Received：12 September 2025，
  
  Revised：2025-10-08，
  
  Accepted：20 October 2025，
  
  Published：28 November 2025
- 稿件说明：
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黄楚霖，林刁珠，尤丽丽，等.糖尿病前期人群成纤维细胞生长因子21水平与慢性肾脏病的关系：一项前瞻性队列研究[J].重庆医科大学学报，2025，50（11）：1493-1499.

Huang Chulin,Lin Diaozhu,You Lili,et al.Association between fibroblast growth factor 21 and chronic kidney disease in individuals with prediabetes： a prospective cohort study[J].Journal of Chongqing Medical University,2025,50(11):1493-1499.
黄楚霖，林刁珠，尤丽丽，等.糖尿病前期人群成纤维细胞生长因子21水平与慢性肾脏病的关系：一项前瞻性队列研究[J].重庆医科大学学报，2025，50（11）：1493-1499. DOI： 10.13406/j.cnki.cyxb.003978.

Huang Chulin,Lin Diaozhu,You Lili,et al.Association between fibroblast growth factor 21 and chronic kidney disease in individuals with prediabetes： a prospective cohort study[J].Journal of Chongqing Medical University,2025,50(11):1493-1499. DOI： 10.13406/j.cnki.cyxb.003978.

摘要

目的

通过开展对40岁以上广州社区人群4年的前瞻性队列研究，探讨在糖尿病前期人群中成纤维细胞生长因子21（fibroblast growth factor-21，FGF21）水平与慢性肾脏病（chronic kidney disease，CKD）的关系。

方法

从2012年REACTION队列中选取1 505例符合糖尿病前期标准且基线资料完整的受试者，随访4年，观察CKD新发情况、尿白蛋白肌酐比值（urinary albumin-to-creatinine ratio，UACR）和估算肾小球滤过率（estimated glomerular filtration rate，eGFR）的变化。

结果

在1 505例糖尿病前期受试者中，142例在4年随访期间达到CKD诊断标准，总体发生率为9.43%（95%CI=7.895%~10.902%）。依据基线血清 FGF21水平由低到高分为Q

4个四分位组，其中Q

组（最高水平组）人群eGFR明显高于其他组（

0.05）。平均随访4 年后，UACR平均增加0.87 mg/g（

0.001），eGFR平均降低4.8 mL/（min·1.73 m

）（

0.001）。按FGF21四分位分层后，各组eGFR下降幅度有差异，Q

组下降最少。在多变量回归模型中，血清FGF21水平与CKD发生呈明显的负向关系。多变量logistic回归分析中，FGF21作为连续变量时，仍与CKD发生风险呈明显负相关，与四分位分组分析结果一致。然而，在限制性立方样条图中，FGF21水平与CKD发生风险存在“L”型非线性关系，即随着FGF21水平升高，CKD发生率下降，但FGF21水平到了一定的阈值后，CKD发生风险不再随FGF21变化。而线性回归分析显示，FGF21与UACR和eGFR呈正相关关系。

结论

在本前瞻性研究队列中，FGF21水平与糖尿病前期人群未来发生CKD的风险可能存在潜在的关联，但其机制与临床价值仍需进一步验证。

Abstract

Objective

To investigate the association between fibroblast growth factor 21（FGF21） and chronic kidney disease（CKD） in a prediabetic population by conducting a 4-year prospective cohort study among community-dwelling residents aged ≥40 years in Guangzhou，China.

Methods

A total of 1505 subjects who met the criteria for prediabetes and had complete baseline data were collected from the 2012 REACTION cohort，and they were followed up for 4 years to observe newly-onset CKD and the changes in urinary albumin-to-creatinine ratio（UACR） and estimated glomerular filtration rate（eGFR）.

Results

Among the 1 505 subjects with prediabetes，142 reached the diagnostic criteria for CKD during follow-up，yielding an overall incidence rate of 9.43%（95%CI=7.895%-10.902%）. According to baseline serum FGF21 level，the subjects were divided into Q

-Q

groups，with the lowest level of FGF21 in the Q1 group，and the Q4 group had a significantly higher eGFR than the othe

r groups（

0.05）. After a mean follow-up time of 4 years，UACR was increased by 0.87 mg/g（

0.001） and eGFR was reduced by 4.8 mL/（min·1.73 m

）（

0.001）. After stratification by FGF21 quartiles，there were differences in the declines of eGFR across groups，with the lowest degree of reduction in the Q

group. In the multivariate regression model，the serum level of FGF21 was significantly negatively associated with the onset of CKD. When FGF21 was analyzed as a continuous variable in the multivariate logistic regression analysis，FGF21 was still significantly negatively associated with the risk of CKD，which was consistent with the results of the quartile-based analysis. However，restricted cubic spline curves showed an L-shaped non-linear relationship between FGF21 level and the risk of CKD，i.e.，the incidence rate of CKD decreased with the increase in FGF21 level，but when FGF21 level reached a certain threshold，the risk of CKD no longer changed with FGF21. The linear regression analysis showed that FGF21 was positively associated with UACR and eGFR.

Conclusion

In this prospective cohort study，FGF21 level might be potentially associated with the future risk of CKD among adults with prediabetes，while further studies are needed to clarify related mechanisms and clinical value.

关键词

Keywords

references

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