Association and predictive value of the visceral adiposity index in diabetic kidney disease: a systematic review and meta-analysis.

OBJECTIVE: The predictive value of the Visceral Adiposity Index (VAI) for diabetic kidney disease (DKD) is unclear. This study systematically reviews the association of elevated VAI with DKD, as well as its predictive performance. METHODS: PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM were searched until December 1, 2025, for studies investigating VAI and DKD. The pooled outcomes and effect measures included odds ratio (OR), hazard ratio (HR), area under the curve (AUC), sensitivity (SEN), specificity (SPEC), and diagnostic 2×2 tables. Additional analyses encompassed sensitivity analysis, heterogeneity assessment, and publication bias evaluation. Statistical analyses were enabled by Stata MP 15.1. RESULTS: Nineteen studies on 58,312 participants were encompassed. Meta-analysis demonstrated that rising VAI was significantly associated with an elevated DKD risk (OR = 1.23, 95% CI: 1.14-1.33; HR = 1.12, 95% CI: 1.09-1.16). The pooled diagnostic performance of VAI for predicting DKD showed an AUC of 0.74 (95% CI: 0.70-0.77), with a SEN of 0.64 (95% CI: 0.55-0.73) and a SPEC of 0.72 (95% CI: 0.63-0.79). CONCLUSIONS: An increased VAI is associated with an elevated DKD risk and serves as an independent predictor. However, its predictive accuracy remains moderate. It cannot yet replace existing standards (such as urinary albumin-to-creatinine ratio (UACR) and the estimated glomerular filtration rate (eGFR)), but may serve as a complementary tool in resource-limited settings. Future research should explore whether combining VAI with other relevant indicators enhances the prediction of DKD risk. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024587271.