Elevated FIB-4 index as a risk marker within the KDIGO framework in patients with type 2 diabetes and hypertension
Main finding · KDIGO 3-4Result — go to the resultOdds ratio 1.57 95% CI 1.12–2.19Authors' conclusion
Elevated FIB-4 is independently associated with KDIGO 3-4 and CKD, and identifies patients with higher vascular comorbidity burden even within KDIGO low-risk categories. FIB-4 may serve as a complementary risk stratification marker within the KDIGO framework for patients with T2DM and hypertension.
Study context
- Population
- Patients with T2D and hypertension; mean age 58.3 years, 60.1% male
- Participants
- 1,208 patients
- Exposure
- FIB-4 >1.3 vs ≤1.3
- FIB-4>1.3n = 514
- Outcome
- KDIGO high/very high risk (categories 3-4)
Main finding
KDIGO 3-4
Odds ratio
1.57
95% CI 1.12–2.19
P = 0.008
FIB-4>1.3vs FIB-4≤1.3
OR 1.57 (95% CI 1.12–2.19); P = 0.008
As reported in the abstract
- Classified as KDIGO 3-4 (all patients)
- 286 (23.7%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| CKD (eGFR <60 mL/min/1.73 m² and/or albumin-to-creatinine ratio ≥30 mg/g)Multivariable-adjusted | 1.51 (1.14–2.01) | P = 0.004 | |
| 0.512Odds ratio (log scale) |
- Chronic kidney disease (CKD) (eGFR <60 mL/min/1.73 m² and/or albumin-to-creatinine ratio ≥30 mg/g) — Met CKD criteria (all patients)
- 588 (48.7%)
Vascular comorbidities within KDIGO low-risk categories
- Elevated FIB-4 associated with significantly higher prevalence of vascular comorbidities
- P for trend < 0.01 for all
Non-linearity of FIB-4 association (restricted cubic spline)
- Non-linear relationship with threshold effect at ≈1.3, KDIGO 3-4
- p value for non-linearity<0.001
- Non-linear relationship, CKD
- P = 0.010
Stratified analyses: patients achieving BMI/LDL-C targets
- Associations persisted among patients achieving BMI/LDL-C targets
- Statistical power was limited for KDIGO 3-4
Original publication
Elevated FIB-4 index as a risk marker within the KDIGO framework in patients with type 2 diabetes and hypertension. BMJ Open Diabetes Res Care. Published 28 April 2026. doi:10.
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