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Observational Study
. 2015 Jun 5;10(6):957-64.
doi: 10.2215/CJN.08540814. Epub 2015 May 15.

Glycated Hemoglobin Level and Mortality in a Nondiabetic Population with CKD

Claire Trivin  1 , Marie Metzger  2 , Jean-Philippe Haymann  2 , Jean-Jacques Boffa  2 , Martin Flamant  2 , François Vrtovsnik  2 , Pascal Houillier  2 , Benedicte Stengel  2 , Eric Thervet  2 ; NephroTest Study Group
Affiliations
Observational Study

Glycated Hemoglobin Level and Mortality in a Nondiabetic Population with CKD

Claire Trivin et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Glycated hemoglobin (HbA1c) is used to diagnose diabetes mellitus (DM) and guide its management. The association between higher HbA1c and progression to ESRD and mortality has been demonstrated in populations with DM. This study examined the association between HbA1c and these end points in a population with CKD and without DM.

Design, setting, participants, & measurements: In the hospital-based NephroTest cohort study, measured GFR (mGFR) was taken by (51)Cr-EDTA renal clearance and HbA1c in 1165 adults with nondialysis CKD stages 1-5 and without DM between January 2000 and December 2010. The median follow-up was 3.48 years (interquartile range, 1.94-5.82) for the competing events of ESRD and pre-ESRD mortality. Time-fixed and time-dependent Cox models were used to estimate hazard ratios (HRs) for ESRD and mortality according to HbA1c, treated continuously or in tertiles.

Results: At inclusion, the mean mGFR was 42.2±19.9 ml/min per 1.73 m(2), and the mean HbA1c value was 5.5%±0.5%. During follow-up, 109 patients died, and 162 patients reached ESRD. Pre-ESRD mortality was significantly associated with HbA1c treated continuously: for every 1% higher HbA1c, the crude HR was 2.16 (95% confidence interval [95% CI], 1.27 to 3.68), and it was 1.85 (95% CI, 1.05 to 3.24) after adjustment for mGFR and other risk factors of death. After excluding incident diabetes over time, the updated mean of HbA1c remained significantly associated with higher mortality risk: adjusted HR for the highest (5.7%-6.4%) versus the lowest tertile (<5.3%) was 2.62 (95% CI, 1.16 to 5.91). There was no association with ESRD risk after adjustment for risk factors of CKD progression.

Conclusions: In a CKD cohort, HbA1c values in the prediabetes range are associated with mortality. Such values should be therefore included among the risk factors for negative outcomes in CKD populations.

Keywords: chronic kidney disease; glycation; mortality risk.

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Figures

Figure 1.
Figure 1.
Study flowchart. *Diabetes defined by a diagnosis of diabetes mellitus in their medical history, use of an antidiabetic treatment, fasting plasma glucose ≥1.26 mg/dl, or glycated hemoglobin (HbA1c) ≥6.5%. mGFR, measured GFR.
Figure 2.
Figure 2.
Kaplan–Meier curves for mortality end points (overall and pre-ESRD) stratified by glycated hemoglobin (HbA1c) tertiles. Log-rank test: P=0.002 (left plot) and P=0.01 (right plot).
Figure 3.
Figure 3.
Kaplan–Meier curves for ESRD end points stratified by glycated hemoglobin (HbA1c) tertiles. Log-rank test: P=0.02. The analysis included 1102 patients with CKD stages 1–4 (exclusion of 63 patients with CKD stage 5).
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References

    1. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE: Defining the relationship between plasma glucose and HbA(1c): Analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care 25: 275–278, 2002 - PubMed
    1. Koenig RJ, Peterson CM, Jones RL, Saudek C, Lehrman M, Cerami A: Correlation of glucose regulation and hemoglobin AIc in diabetes mellitus. N Engl J Med 295: 417–420, 1976 - PubMed
    1. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD: Survival as a function of HbA(1c) in people with type 2 diabetes: A retrospective cohort study. Lancet 375: 481–489, 2010 - PubMed
    1. Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S, Manns B, Bello A, James M, Turin TC, Tonelli M, Alberta Kidney Disease Network : Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: A population-based cohort study. Arch Intern Med 171: 1920–1927, 2011 - PubMed
    1. American Diabetes Association : Diagnosis and classification of diabetes mellitus. Diabetes Care 33[Suppl 1]: S62–S69, 2010 - PMC - PubMed

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