Glycated Hemoglobin and Outcomes in Patients with Advanced Diabetic Chronic Kidney Disease

Sci Rep. 2016 Jan 28:6:20028. doi: 10.1038/srep20028.

Abstract

Diabetes is the major risk factor for end-stage renal disease (ESRD) worldwide. In advanced chronic kidney disease (CKD), less is known about the predictive value of HbA1c. We enrolled 2401 diabetic patients with stage 3-4 and stage 5 CKD, who were classified into 4 groups according to their baseline HbA1c values (<6%, 6%-7%, 7%-9%, and >9%). During the median follow-up of 3 years, 895 patients developed ESRD, and 530 died. In linear regression analysis, higher HbA1c correlated with higher eGFR in patients with stage 5 CKD but not in stage 3-4 CKD. In Cox regression analysis, a trend toward worse clinical outcomes existed when the HbA1c level exceeded 6% in stage 3-4 CKD, but the significance was only observed for >9%. The hazard ratios (HRs) for ESRD, all-cause mortality and combined CV events with mortality in the group of HbA1c >9% were 1.6 (95% CI, 1.07 to 2.38), 1.52 (95% CI, 0.97 to 2.38) and 1.46 (95% CI, 1.02 to 2.09), respectively. This study demonstrates that the higher HbA1c level is associated higher risks for clinical outcomes in diabetic patients with stage 3-4 CKD but not in stage 5 CKD.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Biomarkers
  • Cause of Death
  • Comorbidity
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / metabolism*
  • Diabetic Nephropathies / mortality*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / metabolism*
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / metabolism*
  • Kidney Failure, Chronic / mortality*
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Prognosis
  • Proportional Hazards Models
  • Severity of Illness Index

Substances

  • Biomarkers
  • Glycated Hemoglobin A