Association between prediabetes (defined by HbA1C, fasting plasma glucose, and impaired glucose tolerance) and the development of chronic kidney disease: a 9-year prospective cohort study

Abstract

Background The aim of the present study was to investigate the clinical impact of prediabetes on the development of incident chronic kidney disease (CKD) in a Korean adult population, using data from the Korea Genome and Epidemiology Study. Methods This prospective cohort study included 7728 Korean adults without baseline CKD and type 2 diabetes. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1 C level. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m 2 . We assessed the predictive value of prediabetes for the incidence of CKD, and investigated the incidence of cardiovascular disease including coronary artery disease and stroke. Results Over a median follow-up period of 8.7 years, 871 of 7728 (11.3%) subjects developed incident CKD. Patients with prediabetes, as defined by IGT or HbA1 C , developed incident CKD more frequently than the non-prediabetic group did. The risk of CKD development at follow-up was analyzed according to different prediabetes definitions. Compared with the non-prediabetic group, the IGT- (Hazard ratio [HR] = 1.135, 95% confidence interval [CI] = 1.182–1.310, P = 0.043) and HbA1 C -defined prediabetic groups (HR = 1.391, 95% CI = 1.213–1.595, P < 0.001) were significantly associated with incident CKD after adjusting for traditional CKD risk factors; however, IFG was not associated with incident CKD. Conclusion IGT- or HbA1 C -defined prediabetes is an independent predictor of incident CKD. The measurement of these parameters might enable early detection of CKD risk, allowing physicians to initiate preventive measures and improve patient outcomes.

Chronic Microvascular Complications in Prediabetic States—An Overview

“…For some years, evidence for a correlation between an increased risk of chronic kidney disease (CKD) and diabetic kidney disease (DKD) in prediabetes has been recorded [ 35 , 46 ]. Characteristic features found in 14 cohort studies are summarized in Table 2 [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Half of the studies [ 48 , 49 , 50 , 51 , 52 , 53 , 54 ] were designed mainly to assess the relationship between metabolic syndrome and CKD.…”

“…The size of groups in the presented cohorts ranged from 2398 to 118,924. The European population [ 55 , 56 , 58 ] and the American population [ 47 , 48 , 50 ] were each assessed in three studies, while eight studies concerned the Asian population [ 49 , 51 , 52 , 53 , 54 , 57 , 59 , 60 ]. Some of the European and American studies included multi-ethnic populations, but the white population constituted at least 50% in each of them.…”

“…Five studies additionally included microalbuminuria or proteinuria in the definition of CKD [ 49 , 50 , 53 , 57 , 58 ]. The degree to which the co-variables were adapted differed in particular studies; only six studies included the baseline eGFR [ 47 , 52 , 55 , 57 , 59 , 60 ]. Only in four out of fourteen studies did IFG not increase the probability of CKD [ 53 , 55 , 59 ]; in the remaining studies, it was at least slightly increased.…”

Risk of chronic kidney disease defined by decreased estimated glomerular filtration rate in individuals with different prediabetic phenotypes: results from a prospective cohort study in China

“…16 17 Fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) have been commonly used for the diagnosis of diabetes; and recently, glycated hemoglobin A 1c (HbA 1c ), a measure of long term glucose homeostasis, has also been recommended for diagnosis of diabetes. The KORA study suggested that FPG, 2hPG and HbA 1c were all associated with CKD 15 ; however, studies from China, Japan and Korea indicated that it was elevated HbA 1c or impaired glucose tolerance (IGT), but not impaired fasting glucose (IFG) increased the risk for CKD, [18][19][20] and one study based on the Systolic Blood Pressure Intervention Trial concluded that FPG was not associated with the development of CKD. 21 Therefore, which of these prediabetic glycemic indices is/are genuinely associated with the occurrence of CKD remain unclear.…”

“…34 35 A most recent prospective cohort study from Korea also found that prediabetes was a risk factor for CKD. 20 To the contrary, another cross-sectional 36 and a cohort study 37 suggested otherwise, which is that prediabetes is not a risk factor for CKD. What could be the reason for these discrepancies?…”