Cardiometabolic index is associated with impaired renal function: Nonlinear threshold effects and dose–response relationships in a national cohort (NHANES 1999–2018)

Accurate assessment of renal function is critical for early detection and management of chronic kidney disease (CKD). While estimated glomerular filtration rate (eGFR) remains the gold standard for evaluating renal filtration capacity, its limitations in identifying early metabolic-driven dysfunction necessitate complementary biomarkers. The cardiometabolic index (CMI), reflects metabolic dysregulation but its link to eGFR-defined renal impairment remains unstudied. In this cross-sectional analysis of 13,696 U.S. adults (National Health and Nutrition Examination Survey 1999-2018), eGFR was calculated using the 2021 CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (eGFR < 60 mL/min/1.73m² indicating reduced renal function). CMI, integrating triglyceride-to- high-density-lipoprotein cholesterol ratio (TG/HDL-C) and waist-to-height ratio (WHtR). Weighted multivariable logistic regression models adjusted for sociodemographic, lifestyle, and clinical covariates assessed CMI-eGFR associations. Restricted cubic spline and threshold analyses explored nonlinear relationships, while subgroup analyses tested consistency across populations. Higher CMI quintiles showed a dose-dependent increase in reduced eGFR prevalence (Q1: 5.3% vs Q5: 23.8%, P < .001). Fully adjusted models revealed 2.16-fold elevated odds of reduced eGFR in the highest CMI quintile (95% confidence interval (CI): 1.27-3.69) versus the lowest. Restricted cubic spline analysis identified a nonlinear threshold effect at CMI = 0.182: below this threshold, each 1-unit CMI increase raised eGFR risk by 86% (95% CI = 1.49-2.23; P = .045), while above it, risk increased by 33% (95% CI = 1.11-1.59; P = .002). Subgroup analyses confirmed consistent associations in females, nondiabetics, and older adults (all P < .05), with no significant interactions. Elevated CMI independently predicts reduced renal function, underscoring its utility as a metabolic biomarker for early CKD detection. The identified threshold (CMI ≥ 0.182) highlights a critical inflection point for clinical risk stratification, advocating CMI integration into routine screening to guide preventive strategies against metabolic-driven renal impairment.