The Association between Serum Creatinine, HIV-Infection and Metabolic Variables in Patients Living with Diabetes Mellitus

Abstract

Background: Globally, diabetes mellitus (DM) remains the major aetiological factor for developing end-stage renal disease (ESRD) being characterised by a reduction in glomerular filtration rate (GFR) and a rise in the levels of serum urea and creatinine. No current data is available on the association between creatinine and glycaemic control within the context of HIV infection. Objectives: To determine an association between serum creatinine and glycaemic control in patients living with DM (DM+) in an HIV endemic area. Methods: Standardised clinic sheets were used from the DM clinic at Edendale Hospital, Pietermaritzburg, South Africa, from 1 January 2019 to 31 December 2019. Results: This study had 957 DM+ patients; 622 (69.50%) had creatinine <104umol/l while 273 (30.50%) had creatinine ≥104umol/l (62 with unknown creatinine values). Almost one-sixth of patients had an HIV infection (HIV+) (146, 15.30%). In patients with type 2 DM (DM2+) and HIV+, there was improved glycaemic control (HbA1c 9.03% vs 9.51%, p=0.027). In patients with creatinine <104umol/l, those with CD4 values between 200- 499 cells/uL had poorer glycaemic control when compared to those with CD4 ≥500 cells/uL (10.37% vs 8.91%, p=0.019). Patients with HbA1c levels < 7.00% with creatinine ≥ 104umol/l had significantly higher triglyceride levels than those with creatinine < 104umol/l (2.04 vs 1.43, p=0.001). Conclusion: Serum creatinine is significantly associated with glycaemic control among DM+ patients. Our study suggests elevated creatinine levels place patients into a higher risk category for developing dyslipidaemia and cardiovascular morbidity and mortality, hence screening should form part of the comprehensive management of DM.