Pulse lineResearch With Heart Logo

Poor glycemic control in diabetes and the risk of incident chronic kidney disease even in the absence of albuminuria and retinopathy: Atherosclerosis Risk in Communities (ARIC) Study.

TitlePoor glycemic control in diabetes and the risk of incident chronic kidney disease even in the absence of albuminuria and retinopathy: Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2008
AuthorsBash LD, Selvin E, Steffes M, Coresh J, Astor BC
JournalArch Intern Med
Volume168
Issue22
Pagination2440-7
Date Published2008 Dec 08
ISSN1538-3679
KeywordsAlbuminuria, Chronic Disease, Diabetic Nephropathies, Diabetic Retinopathy, Female, Glycated Hemoglobin A, Humans, Kidney Diseases, Male, Middle Aged, Prospective Studies, Risk Factors
Abstract

BACKGROUND: Diabetic nephropathy is the leading cause of kidney failure in the United States. The extent to which an elevated glycated hemoglobin (HbA(1c)) concentration is associated with increased risk of chronic kidney disease (CKD) in the absence of albuminuria and retinopathy, the hallmarks of diabetic nephropathy, is uncertain.

METHODS: Glycated hemoglobin concentration was measured in 1871 adults with diabetes mellitus followed up for 11 years in the Atherosclerosis Risk in Communities (ARIC) Study. Incident CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) after 6 years of follow-up or a kidney disease-related hospitalization. We categorized HbA(1c) concentrations into 4 clinically relevant categories. Albuminuria and retinopathy were measured midway through follow-up.

RESULTS: Higher HbA(1c) concentrations were strongly associated with risk of CKD in models adjusted for demographic data, baseline glomerular filtration rate, and cardiovascular risk factors. Compared with HbA(1c) concentrations less than 6%, HbA(1c) concentrations of 6% to 7%, 7% to 8%, and greater than 8% were associated with adjusted relative hazard ratios (95% confidence intervals) of 1.4 (0.97-1.91), 2.5 (1.70-3.66), and 3.7 (2.76-4.90), respectively. Risk of CKD was higher in individuals with albuminuria and retinopathy, and the association between HbA(1c) concentration and incident CKD was observed even in participants without either abnormality: adjusted relative hazards, 1.46 (95% confidence intervals, 0.80-2.65), 1.17 (0.43-3.19), and 3.51 (1.67-7.40), respectively; P(trend) = .004.

CONCLUSIONS: We observed a positive association between HbA(1c) concentration and incident CKD that was strong, graded, independent of traditional risk factors, and present even in the absence of albuminuria and retinopathy. Hyperglycemia is an important indicator of risk of both diabetic nephropathy with albuminuria or retinopathy and of less specific forms of CKD.

DOI10.1001/archinte.168.22.2440
Alternate JournalArch Intern Med
PubMed ID19064828
PubMed Central IDPMC2766035
Grant ListN01HC55020 / HL / NHLBI NIH HHS / United States
T32 RR023253 / RR / NCRR NIH HHS / United States
T32 RR023253-02 / RR / NCRR NIH HHS / United States
5T32-HL-007024-33 / HL / NHLBI NIH HHS / United States
N01HC55022 / HL / NHLBI NIH HHS / United States
N01HC55015 / HL / NHLBI NIH HHS / United States
K01 DK076595 / DK / NIDDK NIH HHS / United States
5T32-RR-023253-02 / RR / NCRR NIH HHS / United States
K01 DK076595-01 / DK / NIDDK NIH HHS / United States
N01HC55016 / HL / NHLBI NIH HHS / United States
R01 DK076770 / DK / NIDDK NIH HHS / United States
N01HC55019 / HL / NHLBI NIH HHS / United States
N01HC55021 / HL / NHLBI NIH HHS / United States
5R01-DK-076770-02 / DK / NIDDK NIH HHS / United States
T32 HL007024-33 / HL / NHLBI NIH HHS / United States
N01HC55018 / HL / NHLBI NIH HHS / United States
T32 HL007024 / HL / NHLBI NIH HHS / United States
R01 DK076770-02 / DK / NIDDK NIH HHS / United States