Antonio Ceriello1,2,3, Salvatore De Cosmo4, Maria Chiara Rossi5, Giuseppe Lucisano5, Stefano Genovese3, Roberto Pontremoli6, Paola Fioretto7, Carlo Giorda8, Antonio Pacilli4, Francesca Viazzi6, Giuseppina Russo9, Antonio Nicolucci5. 1. Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 2. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. 3. Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni (MI), Italy. 4. Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy. 5. CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy. 6. Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy. 7. Department of Medicine, University of Padua, Padua, Italy. 8. Department of Internal Medicine, Diabetes and Metabolism Unit, ASL Turin 5, Chieri (TO), Italy. 9. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Abstract
AIM: Variability in HbA1c and blood pressure is associated with the risk of diabetic kidney disease (DKD). No evidence exists on the role of variability in lipids or serum uric acid (UA), or the interplay between the variability of different parameters, in renal outcomes. METHODS: Within the AMD Annals database, we identified patients with ≥5 measurements of HbA1c, systolic blood pressure (SBP) and diastolic blood pressure (DBP), total-, high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol, triglycerides, and UA. Patients were followed-up for up to 5 years. The impact of measures of variability on the risk of DKD was investigated by Cox regression analysis and recursive partitioning techniques. RESULTS: Four-thousand, two-hundred and thirty-one patients were evaluated for development of albuminuria, and 7560 for decreased estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2 ). A significantly higher risk of developing albuminuria was associated with variability in HbA1c [upper quartile hazard ratio (HR) = 1.3; 95% confidence interval (CI) 1.1-1.6]. Variability in SBP, DBP, HDL-C, LDL-C and UA predicted the decline in eGFR, the association with UA variability being particularly strong (upper quartile HR = 1.8; 95% CI 1.3-2.4). The concomitance of high variability in HbA1c and HDL-C conferred the highest risk of developing albuminuria (HR = 1.47; 95% CI 1.17-1.84), while a high variability in UA (HR = 1.54; 95% CI 1.19-1.99) or DBP (HR = 1.47; 95% CI 1.11-1.94) conferred the highest risk of decline in eGFR. CONCLUSION: The variability of several parameters influences the development of DKD, having a different impact on albuminuria development and on the decline in GFR.
AIM: Variability in HbA1c and blood pressure is associated with the risk of diabetic kidney disease (DKD). No evidence exists on the role of variability in lipids or serum uric acid (UA), or the interplay between the variability of different parameters, in renal outcomes. METHODS: Within the AMD Annals database, we identified patients with ≥5 measurements of HbA1c, systolic blood pressure (SBP) and diastolic blood pressure (DBP), total-, high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol, triglycerides, and UA. Patients were followed-up for up to 5 years. The impact of measures of variability on the risk of DKD was investigated by Cox regression analysis and recursive partitioning techniques. RESULTS: Four-thousand, two-hundred and thirty-one patients were evaluated for development of albuminuria, and 7560 for decreased estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2 ). A significantly higher risk of developing albuminuria was associated with variability in HbA1c [upper quartile hazard ratio (HR) = 1.3; 95% confidence interval (CI) 1.1-1.6]. Variability in SBP, DBP, HDL-C, LDL-C and UA predicted the decline in eGFR, the association with UA variability being particularly strong (upper quartile HR = 1.8; 95% CI 1.3-2.4). The concomitance of high variability in HbA1c and HDL-C conferred the highest risk of developing albuminuria (HR = 1.47; 95% CI 1.17-1.84), while a high variability in UA (HR = 1.54; 95% CI 1.19-1.99) or DBP (HR = 1.47; 95% CI 1.11-1.94) conferred the highest risk of decline in eGFR. CONCLUSION: The variability of several parameters influences the development of DKD, having a different impact on albuminuria development and on the decline in GFR.
Authors: Meijian Guan; Jacob M Keaton; Latchezar Dimitrov; Pamela J Hicks; Jianzhao Xu; Nicholette D Palmer; Lijun Ma; Swapan K Das; Yii-Der I Chen; Josef Coresh; Myriam Fornage; Nora Franceschini; Holly Kramer; Carl D Langefeld; Josyf C Mychaleckyj; Rulan S Parekh; Wendy S Post; Laura J Rasmussen-Torvik; Stephen S Rich; Jerome I Rotter; John R Sedor; Denyse Thornley-Brown; Adrienne Tin; James G Wilson; Barry I Freedman; Donald W Bowden; Maggie C Y Ng Journal: Hum Genomics Date: 2019-05-15 Impact factor: 6.481