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Abstract: TH-PO722

Glycemic Status and Mortality Among Patients with CKD

Session Information

• Diabetic and Obesity Induced Kidney Disease - Clinical - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Diabetes

• 502 Diabetes Mellitus and Obesity: Clinical

Authors

• Rhee, Connie, University of California Irvine, Huntington Beach, California, United States

Connie Rhee,



• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,



• Ravel, Vanessa A., Harold Simmons Center, University of California at Irvine, Orange, California, United States

Vanessa A. Ravel,



• Brent, Gregory, VA Greater Los Angeles Healthcare, Los Angeles, California, United States

Gregory Brent,



• Nguyen, Danh V., University of California, Irvine, Irvine, California, United States

Danh V. Nguyen,



• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,



• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

There is uncertainty with regards to the optimal, precise glycemic level in diabetic non-dialysis dependent chronic kidney disease (NDD-CKD) patients. Whereas multiple studies show both lower and higher hemoglobin A1c (HbA1c) levels are associated with worse survival in diabetic dialysis patients, there are sparse data in NDD-CKD patients showing conflicting findings.

Methods

We examined the association of glycemic status, defined by baseline HbA1c, with all-cause mortality among US veterans with diabetes and Stage 3-5 NDD-CKD who underwent ≥1 HbA1c measure(s) over 2004-12 using expanded case-mix+laboratory Cox models. Sensitivity analyses incrementally adjusted for broad categories of anti-diabetic medications (insulin, oral medications) as well as specific categories (biguanides, thiazolidinediones, alpha-glucosidase inhibitors, insulin, insulin secretors, other oral medications).

Results

Among 213,123 patients who met eligibility criteria, both lower HbA1c <6% and higher HbA1c ≥8% were associated with higher mortality (ref: 7-<8%): adjusted HRs (95% CI) 1.63 (1.47-1.81), 1.15 (1.12-1.18), 1.02 (0.99-1.04), 1.09 (1.05-1.13), 1.24 (1.18-1.30), 1.44 (1.38-1.51) for HbA1c <5, 5-<6, 6-<7, 8-<9, 9-<10, and ≥10%, respectively. This pattern of association was robust across analyses incrementally adjusted for broad and specific categories of anti-diabetic medications.

Conclusion

Among diabetic US veterans with NDD-CKD, there was a U-shaped association between HbA1c levels and mortality. Further studies are needed to determine whether treatment to a HbA1c target of 6-<8% improves survival in this population.