Association of HbA1C Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3⁻4.

Mei-Yueh Lee,Pei-Yu Wu,Hsin-Ying Chiou,Jiun-Chi Huang,Szu-Chia Chen

doi:10.3390/ijms19124116

Abstract

Little is known about the predictive value of glycosylated hemoglobin (HbA1C) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA1C variability is associated with progression to end-stage renal disease in diabetic patients with stages 3–5 CKD, and whether different stages of CKD affect these associations. Three hundred and eighty-eight patients with diabetes and stages 3–5 CKD were enrolled in this longitudinal study. Intra-individual HbA1C variability was defined as the standard deviation (SD) of HbA1C, and the renal endpoint was defined as commencing dialysis. The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA1C SD (tertile 3 vs. tertile 1) and a lower risk of the renal endpoint (hazard ratio = 0.175; 95% confidence interval = 0.059–0.518; p = 0.002) in the patients with an HbA1C level ≥ 7% and stages 3–4 CKD, but not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA1C SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA1C. Our results demonstrated that greater HbA1C variability and a decreasing trend of HbA1C, which may be related to intensive diabetes control, was associated with a lower risk of progression to dialysis in the patients with stages 3–4 CKD and poor glycemic control (HbA1c ≥ 7%).

Highlights

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide including Taiwan, where it has been reported to account for approximately 45% of all cases of end-stage renal disease (ESRD) in patients undergoing dialysis
Glucose control has been reported to be an important factor in controlling diabetic nephropathy, and time-averaged mean levels of glycemia, as assessed by glycosylated hemoglobin (HbA1C) level, is the gold standard of treatment to control glycemia and reduce the complications associated with diabetes [1,2]
Lin et al reported a strong association between HbA1C variability and diabetic nephropathy [12], and Luk [13] and Yang [14] reported that HbA1C variability could predict the development of CKD and ESRD, respectively, in patients with type 2 DM and preserved renal function

Summary

Introduction

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide including Taiwan, where it has been reported to account for approximately 45% of all cases of end-stage renal disease (ESRD) in patients undergoing dialysis. Several randomized controlled trials have reported that lowering blood glucose did not appreciably reduce the incidence ESRD or stop the progression of renal function [5,6,7]. This may be because these studies used HbA1C to evaluate glucose control, which did not reflect glucose variability or the risks associated with extreme changes in glucose level over a long period of time [8]. Lin et al reported a strong association between HbA1C variability and diabetic nephropathy [12], and Luk [13] and Yang [14] reported that HbA1C variability could predict the development of CKD and ESRD, respectively, in patients with type 2 DM and preserved renal function

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