Baseline and Longitudinal Metabolic Vulnerability Index and Risk of Incident Chronic Kidney Disease Among Adults With...

The metabolic vulnerability index (MVX) is a novel biomarker reflecting inflammation and metabolic dysregulation, yet its relationship with chronic kidney disease (CKD) in dysglycemic populations remains unestablished. This study aimed to examine the associations of baseline and longitudinal MVX with incident CKD in people with dysglycemia.

This prospective analysis included 50,202 UK Biobank participants with prediabetes or diabetes. MVX was calculated from six nuclear magnetic resonance-based biomarkers: glycoprotein acetyls, small high-density lipoprotein, valine, leucine, isoleucine, and citrate concentrations. Incident CKD was ascertained through health records (International Classification of Diseases-9: 2503; International Classification of Diseases-10: E10.2, E11.2, E13.2, E14.2, N18). Cox models assessed associations between MVX (as continuous, categorical, and longitudinal change) and incident CKD.

During a median 13.4-year follow-up, 5,374 incident CKD cases occurred. Each standard deviation increase in baseline MVX was associated with a 11% higher CKD risk (adjusted hazard ratio [HR], 1.11, 95% confidence interval [CI]: 1.07-1.14). These associations were more pronounced in women and in participants with lower baseline estimated glomerular filtration rate (both P-interaction <0.05). In a longitudinal sub-cohort (n = 2,444), each standard deviation increase in MVX over time was associated with a 21% higher CKD risk (adjusted HR, 1.21, 95% CI: 1.05-1.40). Participants with increasing or persistently high MVX levels had a 44% increased CKD risk (adjusted HR, 1.44; 95% CI: 1.01-2.05) compared to those with stable low levels.

Elevated baseline MVX and a progressive increase in MVX are independently associated with higher CKD risk among dysglycemic adults. The MVX score may help identify high-risk individuals who could benefit from intensified monitoring and early intervention.