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. 2024 Dec;46(2):2416719.
doi: 10.1080/0886022X.2024.2416719. Epub 2024 Oct 28.

Association between albumin-corrected anion gap and kidney function in individuals with hypertension - NHANES 2009-2016 cycle

Hui Jiang  1 , Xiaofeng Lan  1 , Linmeng Zhou  1 , Xiang Xie  1
Affiliations

Association between albumin-corrected anion gap and kidney function in individuals with hypertension - NHANES 2009-2016 cycle

Hui Jiang et al. Ren Fail. 2024 Dec.

Abstract

Objectives: Long-term uncontrolled hypertension increases the risk of kidney decompensation. This study aimed to explore the connection between albumin-corrected anion gap (ACAG) and kidney function in hypertensive patients.

Methods: This study utilized data from 1988 participants diagnosed with hypertension sourced from the NHANES database. Binary logistic regression analysis and subgroup analysis were utilized to investigate the relationship between ACAG and kidney function. The study employed restricted cubic spline (RCS) to assess the non-linear associations between ACAG and eGFR, as well as ACAG and ACR. Furthermore, mediation and moderation effect analyses were carried out, with blood pressure serving as the mediator and moderator, ACAG as the independent variable, and eGFR and ACR as the dependent variables. Finally, the study developed ACAG-based models for predicting kidney function decline.

Results: Higher ACAG is identified as an independent risk factor for eGFR < 60 mL/minute/1.73 m2 and ACR ≥ 30 mg/g. Results from RCS indicate a non-linear relationship between ACAG and eGFR, as well as between ACAG and ACR. The mediation effect analysis revealed that DBP mediated the relationship between ACAG and eGFR. Analysis on moderation effect demonstrated that SBP played a significant role in moderating the interaction between ACAG and ACR. Moreover, the models based on ACAG showed strong performance.

Conclusions: The levels of ACAG are found to be independently associated with both eGFR and ACR. Additionally, ACAG shows promise as a new and dependable biomarker for predicting the decline in kidney function in hypertensive patients.

Keywords: NHANES; albumin-corrected anion gap; hypertension; kidney function.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flowchart of participant selection.
Figure 2.
Figure 2.
Restricted cubic spline (RCS) analysis. (A) No-linear relationship between ACAG and eGFR. (B) No-linear relationship between ACAG and ACR.
Figure 3.
Figure 3.
Diagnostic value of ACAG, AG and ACAG-based lightgbm model evaluation. ROC curve of ACAG and AG predicting (A) eGFR < 60 mL/minute/1.73 m2 and (B) ACR ≥ 30 mg/g. (C) ROC curve and (D) DCA for model predicting eGFR < 60 mL/minute/1.73 m2. (F) ROC curve and (G) DCA for model predicting ACR ≥ 30 mg/g. (E, H) Explaining the effect of ACAG on model output results.
See this image and copyright information in PMC

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