Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study

Abstract

AimTo investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease. MethodsA cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis. ResultsThere were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD ± 9.2), and a mean baseline eGFR 40.7 (±10.7) ml/min/1.73 m2. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95 %CI) for each variability score group, were as follows: 21–40, 1.38 (1.27–1.50); 41–60, 1.54 (1.41–1.68); 61–80, 1.61 (1.45–1.79); and 81–100, 1.42 (1.19–1.68), compared with the group (score 0–20) with least variability. The adjusted sHR for CV were as follows: 6.7–9.9, 1.29 (1.15–1.45); 10.0–13.9, 1.55 (1.39–1.74); 14.0–20.1, 1.79 (1.60–2.01) and ≥20.2, 2.10 (1.88–2.34) compared to reference group 0–6.6. ConclusionsGlycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.