What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Reduced kidney function (n=19416). Intervention: Cumulative cardiometabolic risk factors (CMRFs) vs. No CMRFs. Primary outcome: Moderate/severe eGFR decline (<60 mL/min/1.73 m2) (RRR 6.178, 95% CI 3.718-10.268).

What question did this study set out to answer?

This research aims to clarify the relationship between cumulative cardiometabolic risk factors and kidney function in older adults across China and the U.S.

April 25, 2026Open Access

Cardiometabolic risk burden and kidney function in middle-aged and older adults: evidence from two national, cross-sectional studies in China and the United States

Q: What are the key findings of this study?

The presence of five cardiometabolic risk factors was associated with a significantly higher risk of moderate/severe eGFR decline compared to zero risk factors (RRR 6.178; 95% CI 3.718-10.268).

Q: What does this research mean for the field?

The cumulative burden of cardiometabolic risk factors has a graded association with kidney function decline, where the presence of five risk factors is associated with a significantly higher risk of moderate to severe eGFR decline compared to having zero risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This research aims to clarify the relationship between cumulative cardiometabolic risk factors and kidney function in older adults across China and the U.S.

Key Result

The presence of five cardiometabolic risk factors was associated with a significantly higher risk of moderate/severe eGFR decline compared to zero risk factors (RRR 6.178; 95% CI 3.718-10.268).

Key Points

This research aims to clarify the relationship between cumulative cardiometabolic risk factors and kidney function in older adults across China and the U.S.
Analyzed data from two national studies with 19,416 participants aged ≥45 years.
Calculated estimated glomerular filtration rate (eGFR) using CKD-EPI equations.
Employed multinomial logistic regression to assess the association between cumulative cardiometabolic risk factors and eGFR categories.
Every additional cardiometabolic risk factor increased mild eGFR decline risk (RRR = 1.141, 95% CI: 1.108-1.175).
Significantly higher risk for moderate/severe eGFR decline observed with five risk factors (RRR = 6.178; 95% CI: 3.718-10.268).
eGFR decline was more common in the American population compared to the Chinese population.

Study Design

Type

Cross-Sectional (n=19,416)

Multicenter

Yes

Structured PICO

Does cumulative cardiometabolic risk factor burden increase the risk of estimated glomerular filtration rate decline in middle-aged and older adults?

Population

19,416 participants aged ≥45 years from two nationally representative surveys (China Health and Retirement Longitudinal Study wave 3, N=10,043; U.S. Health and Retirement Study wave 13, N=9,373)

Intervention

Cumulative cardiometabolic risk factors (CMRFs) burden (0 to 5 factors)

Comparator

Participants without cardiometabolic risk factors (0 CMRFs)

Outcome

Estimated glomerular filtration rate (eGFR) decline categorized into normal (≥90 mL/min/1.73 m²), mildly decreased (60-89 mL/min/1.73 m²), and moderately/severely decreased (<60 mL/min/1.73 m²)surrogate

There is a graded association between the cumulative burden of cardiometabolic risk factors and eGFR decline in middle-aged and older adults, highlighting the importance of cardiometabolic screening for kidney health.

Main Result

Effect estimate: RRR 6.178 (95% CI 3.718-10.268)

Abstract

Individual cardiometabolic risk factors (CMRFs) are contributors to reduced kidney function, their cumulative impact and population-specific differences remain unclear. This cross-sectional study investigated the association between incremental CMRFs and estimated glomerular filtration rate (eGFR). We analyzed data from two nationally representative surveys, China Health and Retirement Longitudinal Study wave 3 (N = 10,043) and the U.S. Health and Retirement Study wave 13 (N = 9,373), comprising 19,416 participants aged ≥45 years. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, integrating serum creatinine and cystatin C, were applied to calculate eGFRscr-cysc, categorized into normal (≥90 mL/min/1.73 m2), mildly decreased (60-89 mL/min/1.73 m2), and moderately/severely decreased (2). Multinomial logistic regression was employed to assess the association between cumulative CMRFs (0-5) and eGFRscr-cysc categories, adjusting for covariables. Analyses were conducted on unweighted data without applying complex survey sampling weights. A graded association between the cumulative burden of CMRFs and eGFRscr-cysc decline was observed. Each additional CMRF was associated with an increased risk of mild eGFRscr-cysc decline in the fully adjusted model (relative risk ratio RRR = 1.141, 95% confidence interval 95% CI: 1.108-1.175) and moderate/severe eGFRscr-cysc decline (RRR = 1.433, 95% CI: 1.364-1.505). Participants with five CMRFs had a significantly higher risk of moderate/severe eGFRscr-cysc decline compared to those without CMRFs (RRR = 6.178; 95% CI: 3.718-10.268). Predictive margins showed that eGFRscr-cysc decline was more prevalent in the American population compared to the Chinese population. These cross-sectional findings suggest that integrating routine screening and management of cardiometabolic risk factors into CKD prevention programs may help protect kidney health in aging populations.