Sp428impact of Hba1c Trajectories on Chronic Kidney Disease Progression in Type 2 Diabetes

Low, Kiat Mun Serena; Zhang, Xiao; Wang, Jiexun; Yeoh, Lee Ying; Liu, Yan Lun; Ang, Su Fen; Jeevith, Babitha; Lee, Kok Meng; Tavintharan, Subramaniam; Sum, Chee Fang; Lim, Su Chi

doi:10.1093/ndt/gfy104.sp428

Cited by 2 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on median HbA1c values, the overall level of glycemic control appeared to be generally acceptable, and comparable among patients with CKD compared with those without CKD (median 7.2 vs. 7.1%, p < 0.001). This is important as HbA1c trajectories have been associated with renal disease progression [ 34 ]. Although a wide range of antidiabetic medications were prescribed to patients in both the CKD and non-CKD groups, it was notable that more than 50% of the patients with CKD were receiving long-acting insulins compared with < 40% of those without CKD.…”

Section: Discussionmentioning

confidence: 99%

Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases

Bramlage

Lanzinger

Mark

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundTo evaluate the characteristics of type 2 diabetes (T2DM) patients with or without chronic kidney disease (CKD) in Germany.MethodsUsing combined DPV/DIVE registry data, the analysis included patients with T2DM at least ≥ 18 years old who had an estimated glomerular filtration rate (eGFR) value available. CKD was defined as an eGFR < 60 mL/min/1.73 m2 or eGFR ≥ 60 mL/min/1.73 m2 and albuminuria (≥ 30 mg/g). Median values of the most recent treatment year per patient are reported.ResultsAmong 343,675 patients with T2DM 171,930 had CKD. Patients with CKD had a median eGFR of 48.9 mL/min/1.73 m2 and 51.2% had a urinary albumin level ≥ 30 mg/g. They were older, had a longer diabetes duration and a higher proportion was females compared to patients without CKD (all p < 0.001). More than half of CKD patients (53.5%) were receiving long-acting insulin-based therapy versus around 39.1% of those without (p < 0.001). CKD patients also had a higher rate of hypertension (79.4% vs 72.0%; p < 0.001). The most common antihypertensive drugs among CKD patients were renin-angiotensin-aldosteron system inhibitors (angiotensin converting enzyme inhibitors 33.8%, angiotensin receptor blockers 14.2%) and diuretics (40.2%). CKD patients had a higher rate of dyslipidemia (88.4% vs 86.3%) with higher triglyceride levels (157.9 vs 151.0 mg/dL) and lower HDL-C levels (men: 40.0 vs 42.0 mg/dL; women: 46.4 vs 50.0 mg/dL) (all p < 0.001) and a higher rate of hyperkalemia (> 5.5 mmol/L: 3.7% vs. 1.0%). Comorbidities were more common among CKD patients (p < 0.001).ConclusionThe results illustrate the prevalence and morbidity burden associated with diabetic kidney disease in patients with T2DM in Germany. The data call for more attention to the presence of chronic kidney disease in patients with diabetes, should trigger intensified risk factor control up and beyond the control of blood glucose and HbA1c in these patients. They may also serve as a trigger for future investigations into this patient population asking for new treatment options to be developed.Electronic supplementary materialThe online version of this article (10.1186/s12933-019-0837-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases

Bramlage

Lanzinger

Mark

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…Few empirical studies have explored the prognostic role of longitudinal trends in HbA 1c in patients with type 2 diabetes and CKD. A study of 770 patients with type 2 diabetes and CKD demonstrated that a “moderate increase” HbA 1c trajectory was associated with increased risk of CKD progression compared with a “near-optimal stable” trajectory [ 25 ]. The kidney function of that study population was relatively well preserved (median eGFR = 84.8 mL/min/1.73 m 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…The kidney function of that study population was relatively well preserved (median eGFR = 84.8 mL/min/1.73 m 2 ). In addition, instead of the development of ESKD, CKD progression was defined by a decline in CKD stage with a ≥25% reduction of baseline eGFR [ 25 ]. The consistently observed association between a poor glycemic control trajectory and increased risks of ESKD and mortality in patients with diabetes and CKD highlights the importance of taking proactive measures to prevent hyperglycemic states over the course of CKD care.…”

Section: Discussionmentioning

confidence: 99%

Association of poorly controlled HbA1c with increased risk of progression to end-stage kidney disease and all-cause mortality in patients with diabetes and chronic kidney disease

et al. 2022

View full text Add to dashboard Cite

Glycosylated hemoglobin (HbA1c) targets for patients with chronic kidney disease (CKD) and type 2 diabetes remain controversial. To evaluate whether baseline HbA1c and HbA1c trajectories are associated with the risk of end-stage kidney disease (ESKD) and all-cause mortality, we recruited adult patients with CKD and type 2 diabetes from a “Pre-ESKD Program” at a medical center in Taiwan from 2003 to 2017. Group-based trajectory modeling was performed to identify distinct patient groups that contained patients with similar longitudinal HbA1c patterns. Cox proportional hazard models were used to estimate hazard ratios (HRs) of ESKD and mortality associated with baseline HbA1c levels and HbA1c trajectories. In the analysis related to baseline HbA1c (n = 4543), the adjusted HRs [95% confidence interval (CI)] of all-cause mortality were 1.06 (0.95–1.18) and 1.25 (95% CI, 1.07–1.46) in patients with an HbA1c level of 7%–9% (53–75 mmol/mol) and >9% (>75 mmol/mol), respectively, as compared with those with an HbA1c level < 7% (<53 mmol/mol). In the trajectory analysis (n = 2692), three distinct longitudinal HbA1c trajectories were identified: nearly optimal (55.9%), moderate to stable (34.2%), and poor control (9.9%). Compared with the “nearly optimal” HbA1c trajectory group, the “moderate-to-stable” group did not have significantly higher mortality, but the “poorly controlled” group had 35% higher risk of mortality (adjusted HR = 1.35, 95% CI = 1.06–1.71). Neither baseline levels of HbA1c nor trajectories were associated with ESKD risk. In conclusion, in patients with CKD and type 2 diabetes, poor glycemic control was associated with an elevated risk of mortality but not associated with a risk of progression to ESKD.

show abstract

Sp428impact of Hba1c Trajectories on Chronic Kidney Disease Progression in Type 2 Diabetes

Cited by 2 publications

References 0 publications

Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases

Patient and disease characteristics of type-2 diabetes patients with or without chronic kidney disease: an analysis of the German DPV and DIVE databases

Association of poorly controlled HbA1c with increased risk of progression to end-stage kidney disease and all-cause mortality in patients with diabetes and chronic kidney disease

Contact Info

Product

Resources

About