Prediabetes and the risk of incident chronic kidney disease in adults: A systematic review and meta-analysis

Abstract

The relationship between prediabetes and chronic kidney disease (CKD) remains ambiguous, with varying results across cohort studies. This meta-analysis aimed to assess whether prediabetes is linked to an increased risk of developing incident CKD in the general adult population. A comprehensive search was conducted in PubMed, Embase, and Web of Science from inception to September 28, 2025, for longitudinal observational studies that evaluated CKD risk in individuals with prediabetes compared to those with normoglycemia. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), elevated glycated hemoglobin (HbA1c), or a combination of these criteria. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Fifteen cohorts comprising 2,854,724 participants were included in the analysis. The results indicated that prediabetes was significantly associated with an increased risk of incident CKD (RR: 1.21, 95% CI: 1.12–1.31; I² = 90%). Subgroup analyses revealed that the association was not significantly influenced by the definitions of prediabetes, study design, demographic characteristics of the population, follow-up duration, or study quality scores (p for subgroup difference all > 0.05). Meta-regression analysis suggested that a higher mean age of the population was inversely correlated with the observed effect size for the relationship between prediabetes and CKD risk (coefficient = -0.030, p = 0.004; adjusted R² = 67%). In conclusion, prediabetes is associated with a modestly elevated risk of developing CKD in the general population, with a potentially stronger correlation observed in younger individuals. These findings indicate an association rather than causality and suggest that early glycemic dysregulation may be linked to subsequent renal risk prior to the onset of overt diabetes.