Glycemic control and cardiovascular disease in chronic kidney disease.

Diabetes increases cardiovascular (CV) risk to a similar extent as myocardial infarction. Epidemiologic data support the same concept for the presence of Stage 3 (ie, glomerular filtration rate of < 60 mL/min) or higher nephropathy without diabetes. The most common cause of end-stage kidney disease requiring dialysis is diabetes. Hence, CV risk is highest among those with kidney disease and diabetes. Glycemic control in the context of CV risk reduction among patients with kidney disease has not been the focus of any specific trial; however, secondary analyses of trials, primarily in type 1 diabetes, have looked at this issue. Nevertheless, the outcome data are sparse. What can be said, however, is that failure to achieve reasonable glycemic control (ie, glycated hemoglobin < 7.5%) is associated with a higher risk of CV events and hospitalizations for CV events and infections among those with advanced kidney disease. The impact of poor glycemic control on kidney disease progression has not been well studied and should be the focus of future studies.