Sankar D Navaneethan1, Jesse D Schold2, Stacey E Jolly3, Susana Arrigain4, Wolfgang C Winkelmayer5, Joseph V Nally4. 1. Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address: sankar.navaneethan@bcm.edu. 2. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. 3. Medicine Institute, Cleveland Clinic, Cleveland, OH. 4. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. 5. Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Abstract
BACKGROUND: Diabetes is the leading cause of end-stage renal disease (ESRD) and a significant contributor to mortality in the general population. We examined the associations of hemoglobin A1c (HbA1c) levels with ESRD and death in a population with diabetes and chronic kidney disease (CKD). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 6,165 patients with diabetes (treated with oral hypoglycemic agents and/or insulin) and CKD stages 1 to 5 at a large health care system. PREDICTOR: HbA1c level (examined as a categorical and continuous measure). OUTCOMES: All-cause and cause-specific mortality ascertained from the Ohio Department of Health mortality files and ESRD ascertained from the US Renal Data System. RESULTS: During a median 2.3 years of follow-up, 957 patients died (887 pre-ESRD deaths) and 205 patients reached ESRD. In a Cox proportional hazards model, after multivariable adjustment including for kidney function, HbA1c level < 6% was associated with higher risk for death when compared with HbA1c levels of 6% to 6.9% (HR, 1.23; 95% CI, 1.01-1.50). Similarly, HbA1c level ≥ 9% was associated with higher risk for all-cause death (HR, 1.34; 95% CI, 1.06-1.69). In competing-risk models, baseline HbA1c level was not associated with ESRD. For cause-specific mortality, diabetes accounted for >12% of deaths overall and >19% of deaths among those with HbA1c levels > 9%. LIMITATIONS: Small proportion of participants with advanced kidney disease; single-center population. CONCLUSIONS: In this cohort of patients with CKD with diabetes, HbA1c levels < 6% and ≥9% were associated with higher risk for death. HbA1c levels were not associated with ESRD in this specific CKD population. Diabetes-related deaths increased with higher HbA1c levels.
BACKGROUND:Diabetes is the leading cause of end-stage renal disease (ESRD) and a significant contributor to mortality in the general population. We examined the associations of hemoglobin A1c (HbA1c) levels with ESRD and death in a population with diabetes and chronic kidney disease (CKD). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 6,165 patients with diabetes (treated with oral hypoglycemic agents and/or insulin) and CKD stages 1 to 5 at a large health care system. PREDICTOR: HbA1c level (examined as a categorical and continuous measure). OUTCOMES: All-cause and cause-specific mortality ascertained from the Ohio Department of Health mortality files and ESRD ascertained from the US Renal Data System. RESULTS: During a median 2.3 years of follow-up, 957 patients died (887 pre-ESRD deaths) and 205 patients reached ESRD. In a Cox proportional hazards model, after multivariable adjustment including for kidney function, HbA1c level < 6% was associated with higher risk for death when compared with HbA1c levels of 6% to 6.9% (HR, 1.23; 95% CI, 1.01-1.50). Similarly, HbA1c level ≥ 9% was associated with higher risk for all-cause death (HR, 1.34; 95% CI, 1.06-1.69). In competing-risk models, baseline HbA1c level was not associated with ESRD. For cause-specific mortality, diabetes accounted for >12% of deaths overall and >19% of deaths among those with HbA1c levels > 9%. LIMITATIONS: Small proportion of participants with advanced kidney disease; single-center population. CONCLUSIONS: In this cohort of patients with CKD with diabetes, HbA1c levels < 6% and ≥9% were associated with higher risk for death. HbA1c levels were not associated with ESRD in this specific CKD population. Diabetes-related deaths increased with higher HbA1c levels.
Authors: Sankar D Navaneethan; Stacey E Jolly; Jesse D Schold; Susana Arrigain; Welf Saupe; John Sharp; Jennifer Lyons; James F Simon; Martin J Schreiber; Anil Jain; Joseph V Nally Journal: Clin J Am Soc Nephrol Date: 2010-11-04 Impact factor: 8.237
Authors: Marcello Tonelli; Paul Muntner; Anita Lloyd; Braden J Manns; Scott Klarenbach; Neesh Pannu; Matthew T James; Brenda R Hemmelgarn Journal: Lancet Date: 2012-06-19 Impact factor: 79.321
Authors: Ian H de Boer; Tessa C Rue; Yoshio N Hall; Patrick J Heagerty; Noel S Weiss; Jonathan Himmelfarb Journal: JAMA Date: 2011-06-22 Impact factor: 56.272
Authors: Hertzel C Gerstein; Michael E Miller; Robert P Byington; David C Goff; J Thomas Bigger; John B Buse; William C Cushman; Saul Genuth; Faramarz Ismail-Beigi; Richard H Grimm; Jeffrey L Probstfield; Denise G Simons-Morton; William T Friedewald Journal: N Engl J Med Date: 2008-06-06 Impact factor: 91.245
Authors: Sankar D Navaneethan; Jesse D Schold; Susana Arrigain; John P Kirwan; Joseph V Nally Journal: Kidney Int Date: 2016-01-12 Impact factor: 10.612
Authors: Muh Geot Wong; Vlado Perkovic; John Chalmers; Mark Woodward; Qiang Li; Mark E Cooper; Pavel Hamet; Stephen Harrap; Simon Heller; Stephen MacMahon; Giuseppe Mancia; Michel Marre; David Matthews; Bruce Neal; Neil Poulter; Anthony Rodgers; Bryan Williams; Sophia Zoungas Journal: Diabetes Care Date: 2016-03-22 Impact factor: 19.112
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Suetonia C Palmer; Dimitris Mavridis; Eliano Navarese; Jonathan C Craig; Marcello Tonelli; Georgia Salanti; Natasha Wiebe; Marinella Ruospo; David C Wheeler; Giovanni F M Strippoli Journal: Lancet Date: 2015-05-23 Impact factor: 79.321
Authors: Yang Xu; Aditya Surapaneni; Jim Alkas; Marie Evans; Jung-Im Shin; Elizabeth Selvin; Alex Chang; Morgan E Grams; Juan Jesus Carrero Journal: Diabetes Care Date: 2020-10-06 Impact factor: 19.112
Authors: Medha Airy; Jesse D Schold; Stacey E Jolly; Susana Arrigain; Nisha Bansal; Wolfgang C Winkelmayer; Joseph V Nally; Sankar D Navaneethan Journal: Am J Nephrol Date: 2018-07-26 Impact factor: 3.754
Authors: Thilini W Hettiarachchi; Buddhi N T W Fernando; Thilini Sudeshika; Zeid Badurdeen; Shuchi Anand; Ajith Kularatne; Sulochana Wijetunge; Hemalika T K Abeysundara; Nishantha Nanayakkara Journal: PLoS One Date: 2021-04-14 Impact factor: 3.752