The association between computed tomography-based intrapancreatic fat deposition and renal function

Ectopic fat deposition in non-adipose organs is increasingly recognized as a driver of chronic metabolic disease, yet the relationship between intrapancreatic fat and impaired renal function remains poorly defined. We investigated whether pancreatic steatosis, quantified by computed-tomography (CT) attenuation, is independently associated with impaired renal function in a large Chinese health-screening cohort. This cross-sectional study included adults (≥ 20 years) who underwent low-dose chest CT and same-day serum creatinine measurement at the Nanjing University of Chinese Medicine between 2018 and 2021. Pancreatic fat was assessed by mean CT attenuation (PanCT) and the pancreas-to-spleen attenuation ratio (P/S). Impaired renal function was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m². Among 9,432 participants (mean age 51.6 ± 15.4 years; 60.7% male), 232 (2.5%) had CKD. Both PanCT and P/S decreased monotonically with increasing impaired renal function prevalence across quartiles (p-trend < 0.001). The highest quartiles of PanCT (> 50.2 HU) and P/S (> 1.03) were associated with 48% (OR 0.52; 95% CI 0.27–0.99) and 54% (OR 0.46; 95% CI 0.23–0.90) lower odds of impaired renal function, respectively, compared with the lowest quartiles. Restricted cubic splines revealed a linear inverse relationship, and subgroup analyses confirmed consistency in non-diabetic, non-hypertensive, and high-liver-fat individuals. Greater intrapancreatic fat deposition is independently associated with increased risk of impaired renal function in Chinese adults.