Risk factors for diabetic kidney disease in type 2 diabetes mellitus in Asia: a meta-analysis

Background: Diabetic kidney disease (DKD) is a highly significant microvascular complication that arises from diabetes. Therefore, this study aimed to ascertain the traditional risk factors for DKD in type 2 diabetes mellitus (T2DM) in Asia, raising awareness of these risk factors among patients with T2DM. Methods: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched until 13 Mar 2026. Case-control or cohort studies in Asia on the risk factors for DKD were included. Egger's test and funnel plots were used to assess publication bias. Stata 15 was used for statistical analysis. Results: 7 case-control studies (including 3,312 participants) and 17 cohort studies (including 8,735 participants) were included. All the included studies were of high quality according to the Newcastle-Ottawa Scale (NOS). Systolic blood pressure (SBP), hypertension, glycosylated hemoglobin (HbA1c), waist-to-hip ratio (WHR), fasting blood glucose (FBG), uric acid (UA), creatinine (Cr), age and diabetes duration were risk factors for DKD in T2DM. Diabetic retinopathy (DR) was closely associated with DKD, and this association was also evident in subgroups defined by pathological diagnosis. SBP was a risk factor in both the clinical diagnosis group and the pathological diagnosis group. Conclusions: This meta-analysis preliminarily demonstrates that SBP, hypertension, HbA1c, WHR, FBG, UA, Cr, age, diabetes duration and DR are associated with DKD in Asia. SBP and DR are associated with renal biopsy-confirmed DKD. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, identifier CRD42024529789.