Hypertension and BMI as Mediators of Type 2 Diabetes-Induced CKD: Insights from an Integrative Multi-Database Study

Chronic kidney disease is a major global health concern, with type 2 diabetic nephropathy (T2DN) significantly contributing to its burden. This study examines global trends, key risk factors, and clinical characteristics of T2DN to identify modifiable contributors and inform precision management.

Data from the 2021 GBD Study, Mendelian randomization (MR) analyses, NHANES, and a clinical cohort were utilized. Trends in prevalence, incidence, mortality, disability-adjusted life years (DALYs), and population-attributable fractions (PAF) of T2DN risk factors were analyzed globally and across sociodemographic strata. Genetic determinants were identified via two-sample and multivariable MR, while clinical data were analyzed using regression and correlation analyses.

Between 1990 and 2021, T2DN prevalence, incidence, and DALYs increased globally, and the global mortality rate rose from 5.73 (4.81, 6.83) to 10.25 (8.62, 12.15). High fasting plasma glucose was the primary risk factor, with rising PAFs for high BMI and systolic blood pressure (SBP), and the global PAF for deaths due to T2DN attributed to high fasting plasma glucose increased from 0.80 to 0.90. MR analysis confirmed causal links between fasting glucose (β = 1.351, P = 2.78e-4), insulin (β = 2.543, P = 1.20e-5), T2DM (OR = 2.280, P = 4.14e-29) and T2DN risk, with BMI and SBP influencing disease progression. NHANES data showed BP's impact on renal function. A diagnostic model incorporating age, categorical blood pressure data, history of heart failure, and history of stroke was developed, with an AUC of 0.716. In the clinical cohort, T2DN correlated with elevated urinary albumin-to-creatinine ratio, serum creatinine, BP, and BMI variations.

T2DM progression to T2DN is driven by hyperglycemia, BMI, and BP, highlighting the need for targeted interventions.