The incidence and prevalence of chronic kidney disease (CKD) remain high. Hypertension and diabetes frequently coexist and jointly accelerate the progression of kidney disease. The lipid accumulation product index (LAPI) is a novel indicator for predicting cardiovascular disease and abnormalities in glucose metabolism, and its relationship with CKD warrants further investigation.

This study aimed to investigate the relationship between LAPI and the risk of developing CKD in patients with hypertension and abnormal glucose metabolism.

A retrospective cohort of 2 033 patients with hypertension and abnormal glucose metabolism admitted to the Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region from January 2012 to May 2019 was enrolled. General patient information and laboratory test indicators were collected. The LAPI was calculated, and the population was divided into four groups based on LAPI quartiles: Q1 (LAPI≤44.03, n=509), Q2 (44.03<LAPI≤64.68, n=508), Q3 (64.68<LAPI≤98.90, n=508), and Q4 (LAPI>98.90, n=508). Patients were followed up, with the endpoint event being CKD. Kaplan-Meier curves were used to analyze the cumulative incidence of CKD at different LAPI levels, and the Log-rank test was used to compare differences. Multivariate Cox regression models were employed to analyze the relationship between LAPI and CKD. Restricted cubic splines were fitted to the multivariate Cox regression model to explore the dose-response relationship between LAPI and CKD. Subgroup analysis and sensitivity analysis were conducted to test the stability of the relationship between LAPI and CKD.

Significant differences were observed in age, gender, BMI, waist circumference, heart rate, diastolic blood pressure, smoking, alcohol consumption, uric acid, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, glycated hemoglobin, fasting blood glucose, use of calcium channel blockers, and hypoglycemic treatment among the 4 groups (P<0.05). Log-rank test results indicated that the cumulative risk of CKD increased with elevating LAPI levels (χ²=14.48, P<0.001). Multivariate Cox regression analysis revealed that for each standard deviation increase in LAPI, the hazard ratio (HR) for CKD increased by 12.5% (HR=1.125, 95%CI=1.035-1.223, P=0.005) ; compared to the Q1 group, the Q4 group had a 54.9% higher risk of CKD (HR=1.549, 95%CI=1.129-2.125, P=0.007). Restricted cubic spline regression analysis showed that LAPI>65.59 was a risk factor for CKD (P=0.007). Interaction and subgroup analyses revealed that the association between LAPI and the risk of developing CKD remained stable.

In patients with hypertension and abnormal glucose metabolism, a higher LAPI in the early stages increases the risk of developing CKD.

目前慢性肾脏病（CKD）发病率和流行率仍较高。高血压和糖尿病常共存，并共同加速肾脏疾病的进展。脂质蓄积指数（LAPI）是预测心血管疾病和糖代谢异常的新指标，与CKD的关系有待研究。

本研究旨在探讨高血压伴糖代谢异常患者LAPI与CKD发生风险的关系。

回顾性纳入2012年1月—2019年5月收治于新疆维吾尔自治区人民医院高血压中心的2 033例高血压伴糖代谢异常患者为研究对象，收集患者一般资料与实验室检查指标。计算LAPI，按LAPI四分位数将人群资料分为四组，Q1组（LAPI≤44.03，n=509），Q2组（44.03<LAPI≤64.68，n=508），Q3组（64.68<LAPI≤98.90，n=508），Q4组（LAPI>98.90，n=508），对患者进行随访，随访终点事件为CKD。采用Kaplan-Meier曲线分析不同LAPI水平的CKD的累积发生率，并采用Log-rank检验比较差异。多因素Cox回归模型分析LAPI与CKD的关系。采用限制性立方样条曲线拟合多因素Cox比例回归模型探索LAPI与CKD的效应关系。采用亚组分析和敏感性分析检验LAPI与CKD关系的稳定性。

4组年龄、性别、BMI、腰围、心率、舒张压、吸烟、饮酒、尿酸、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、空腹血糖、服用钙离子拮抗剂、降糖治疗比较，差异有统计学意义（P<0.05）。Log-rank检验结果显示，随着LAPI水平升高，Q1~Q4组CKD累积风险升高（χ²=14.48，P<0.001）。多因素Cox回归分析结果显示，LAPI每增加1个标准差，CKD的风险比例升高12.5%（HR=1.125，95%CI=1.035~1.223，P=0.005）；Q4组较Q1组CKD的风险比例升高了54.9%（HR=1.549，95%CI=1.129~2.125，P=0.007）。限制性样条回归曲线结果显示，LAPI>65.59为CKD的危险因素（P=0.007）。交互分析和亚组分析结果显示，LAPI与发生CKD风险的关系仍然稳定。

在高血压伴糖代谢异常的患者中，早期较高的LAPI会增加CKD的发生风险。