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Kidney Week

Abstract: TH-PO722

Glycemic Status and Mortality Among Patients with CKD

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Rhee, Connie, University of California Irvine, Huntington Beach, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Ravel, Vanessa A., Harold Simmons Center, University of California at Irvine, Orange, California, United States
  • Brent, Gregory, VA Greater Los Angeles Healthcare, Los Angeles, California, United States
  • Nguyen, Danh V., University of California, Irvine, Irvine, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
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.