There was a synergistic effect of CKD and a high SD of annual eGFR on mortality prediction, with an HR of 2.382 (95% CI 1.346‒4.215) after adjusting for age, sex, current smoking status, CVD history, obesity, duration of DM, hypertension, HbA1c, total cholesterol, HDL cholesterol, triglycerides, albuminuria, the use of ACE inhibitors or ARBs, and the use of statins, antiplatelet agents, insulin, metformin, and SGLT2 inhibitors (Table 2). Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.