Publication:
The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease

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Issued Date

2019

Resource Type

Article

File Type

application/pdf

ISSN

10568727

DOI

10.1016/j.jdiacomp.2018.12.010

Other identifier(s)

2-s2.0-85061702864

Rights Holder(s)

มหาวิทยาลัยศรีนครินทรวิโรฒ

Bibliographic Citation

Journal of Diabetes and its Complications. Vol 33, No.4 (2019), p.296-301

Suggested Citation

Limkunakul C., De Boer I.H., Kestenbaum B.R., Himmelfarb J., Ikizler T.A., Robinson-Cohen C. The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease. Journal of Diabetes and its Complications. Vol 33, No.4 (2019), p.296-301. doi:10.1016/j.jdiacomp.2018.12.010 Retrieved from: https://hdl.handle.net/20.500.14740/5402

Title

The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease

Author(s)

Limkunakul C.
 De Boer I.H.
 Kestenbaum B.R.
 Himmelfarb J.
 Ikizler T.A.
 Robinson-Cohen C.

Abstract

Context: Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear. Objective: We examined the associations of HbA1c with risks of progression to ESKD and death within a clinic-based study of CKD. We hypothesized that higher HbA1c concentrations would be associated with increased risks of ESKD and death. Design and setting: We studied 618 participants from the Seattle Kidney Study (mean eGFR 42 ml/min), 308 of whom had diabetes, and tested associations of baseline HbA1c with time to a composite outcome of initiation of renal replacement therapy or death. Results: During a median follow-up of 4.2 years, there were 343 instances of the composite outcome (11.5 per 100 person-years). Among participants with diabetes, in both crude and adjusted analyses, higher HbA1c levels (examined continuously or categorically) were not associated with the risk of the composite outcome (HR (95% CI): 0.99 (0.88, 1.10) per 1% additional HbA1c, p = 0.79). HbA1c was not associated with ESKD or mortality when the outcomes were examined separately, nor when stratified between insulin users and non-users. Conclusion: In a referred population of established DKD, higher HbA1c was not associated with higher risk of ESKD or death. These data support current recommendations to be conservative with glycemic control among patients with advanced diabetes complications, such as CKD. © 2019 Elsevier Inc.

Subject(s)

Hemoglobin A1c
 Glycosylated hemoglobin
 Adult
 Article
 Chronic kidney failure
 Cohort analysis
 Diabetic nephropathy
 Disease association
 End stage renal disease
 Female
 Follow up
 Human
 Major clinical study
 Male
 Mortality
 Outcome assessment
 Priority journal
 Prospective study
 Renal replacement therapy
 Risk assessment
 Aged
 Blood
 Chronic kidney failure
 Diabetes mellitus
 Diabetic nephropathy
 Disease exacerbation
 Epidemiology
 Glomerulus filtration rate
 Metabolism
 Middle aged
 Very elderly
 Washington
 Adult
 Aged
 Aged, 80 and over
 Diabetes Mellitus
 Diabetic Nephropathies
 Disease Progression
 Female
 Glomerular Filtration Rate
 Glycated Hemoglobin A
 Humans
 Kidney Failure, Chronic
 Male
 Middle Aged
 Renal Insufficiency, Chronic
 Washington

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URI

https://hdl.handle.net/20.500.14740/5402

Collections

Scopus: Year 1983-2021

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