Associations of ABC (Hemoglobin A1c, Blood Pressure and Low-Density Lipoprotein Cholesterol) Goal Achievement With Chronic Kidney Disease in Type 2 Diabetic Patients With Preserved Kidney Function

Satomi Minato; Akiko Takenouchi; Kaori Kitaoka; Mika Takeuchi; Ayaka Tsuboi; Miki Kurata; Keisuke Fukuo; Tsutomu Kazumi

doi:10.14740/jocmr4001

Associations of ABC (Hemoglobin A1c, Blood Pressure and Low-Density Lipoprotein Cholesterol) Goal Achievement With Chronic Kidney Disease in Type 2 Diabetic Patients With Preserved Kidney Function

J Clin Med Res. 2019 Dec;11(12):818-824. doi: 10.14740/jocmr4001. Epub 2019 Nov 24.

Authors

Satomi Minato^{1

2}, Akiko Takenouchi³, Kaori Kitaoka^{1

4}, Mika Takeuchi^{1

5}, Ayaka Tsuboi^{1

6}, Miki Kurata^{1

3}, Keisuke Fukuo^{1

3}, Tsutomu Kazumi^{1

7}

Affiliations

¹ Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.
² Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan.
³ Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.
⁴ Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan.
⁵ Department of Food Sciences and Nutrition, Faculty of Human Life and Environmental Sciences, Nagoya Women's University, Nagoya, Japan.
⁶ Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan.
⁷ Diabetes Division, Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, Japan.

Abstract

Background: We investigated cross-sectional and prospective associations of ABC (hemoglobin A1c (HbA1c), blood pressure and low-density lipoprotein cholesterol) goal attainment with chronic kidney disease. Cross-sectional association with carotid intima-media thickness (IMT) was evaluated as well.

Methods: Prevalence of low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m²) and albuminuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g) were assessed at baseline and after a median follow-up of 6.0 years in 168 patients with type 2 diabetes with preserved kidney function (aged 62.3 years, 53.6% men). Carotid IMT was measured at baseline only.

Results: At baseline, 47 (28.0%), 45 (26.8%), 63 (37.5%) and 13 (7.7%) patients achieved triple-goal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC targets was associated with lower log ACR (P < 0.01), lower percentage of albuminuria (P = 0.02), and lower carotid IMT (P < 0.01) at baseline. Over 6.0 years, eGFR decreased from 76 ± 16 to 67 ± 18 mL/min/1.73 m² (P < 0.01) whereas ACR levels did not change. There were 32 patients with incident reduced eGFR, eight with GFR stage progression, 15 with progression of albuminuric stages and five with doubling of ACR within the microalbuminuric range. Achieving more ABC targets decreased the percentage of deterioration of GFR stages (30.8%, 28.6%, 24.4% and 14.9%, respectively, P = 0.01). Achieving two or more (8.9% and 8.5%, respectively) compared with one or less ABC targets (15.4% and 15.9%, respectively) was associated with less deterioration of albuminuria (P < 0.001). Although achieving more ABC targets was associated with lower annual decline in eGFR, the difference was not significant.

Conclusions: ABC goal achievement has shown cross-sectional and prospective associations with deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function. Cross-sectional association with carotid IMT has been demonstrated as well. Reaching more ABC treatment targets may be important for preventing adverse renal outcomes.

Keywords: Albuminuria; Blood pressure; Glomerular filtration rate; HbA1c; LDL cholesterol.