Association of the oxidative balance score and chronic kidney disease: insights from the national health and nutrition examination survey 2009-2018

Abstract

Introduction: Oxidative stress plays a pivotal role in the pathogenesis of chronic kidney disease (CKD). The oxidative balance score (OBS) was devised to quantify the overall oxidative state, integrating pro-oxidant and antioxidant influences from both dietary intake and lifestyle practices. The aim of this study was to delve into the relationship between the OBS and CKD within the adult population of the United States.

Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2009-2018, we derived the OBS from 16 dietary and four lifestyle factors. We employed weighted multivariate regression to probe the link between OBS and CKD. Additionally, we undertook subgroup analyses and applied Restricted Cubic Spline Regression (RCS) for further data analyses.

Results: This study encompassed 19,444 participants. Logistic regression analysis consistently demonstrated a protective effect of higher OBS on CKD. In Model 3, each unit increase in OBS was associated with a 2% reduction in the risk of CKD (95% CI: 0.97-0.99, p < 0.001) and a 4% reduction in the risk of reduced estimated glomerular filtration rate (eGFR) (95% CI: 0.95-0.98, p < 0.001). The highest OBS quintile (Q4) also showed significant reductions in the risk of CKD (OR: 0.66, 95% CI: 0.53-0.82, p < 0.001) and reduced eGFR (OR: 0.51, 95% CI: 0.37-0.69, p < 0.001) in Model 3. RCS analysis revealed a linear relationship between OBS and CKD. Subgroup analyses indicated significant associations between OBS and CKD in most subgroups, except for those without hypertension or with cardiovascular disease. Additionally, interaction analyses demonstrated that age, hypertension, and diabetes significantly modify the association between OBS and CKD risk.

Conclusion: An elevated OBS, reflecting a predominance of antioxidants, correlates with a diminished CKD risk in the American adult demographic. These insights emphasize the potential influence of oxidative equilibrium on the development of CKD.

Keywords: NHANES; antioxidants; chronic kidney disease; cross-sectional study; oxidative balance score.

Figure 1

A flowchart showing the selection of study participants.

Figure 2

The restricted cubic spline regression between OBS and kidney function. The dose–response relationship was assessed using restricted cubic spline regression for the OBS in relation to kidney function outcomes, including chronic kidney disease (CKD) (A), decreased estimated glomerular filtration rate (eGFR) (B), and proteinuria prevalence (C), with adjustments for covariates as specified in Model 3. The red line represents the odds ratio (OR), while the shaded pink area indicates the 95% confidence interval (CI). Decreased eGFR is defined as an eGFR less than 60 mL/min/1.73 m², and proteinuria prevalence is defined as a urine albumin-to-creatinine ratio (UACR) of 30 mg/g or greater. The linearity test results suggest that the relationship between OBS and each kidney function measure is non-linear, indicating potential thresholds or varying effects at different OBS levels.

Figure 3

Association between the OBS and CKD in subgroup and interactive analyses. OBS, oxidative balance score. CKD, chronic kidney disease.

Figure 4

Association between OBS quartiles and CKD in subgroups. OBS, oxidative balance score. CKD, chronic kidney disease.