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Abstract: SA-PO453

HbA1c-Dependent Projection of Long-Term Renal Outcomes

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Welte, Thomas, Universitatsklinikum Freiburg Innere Medizin, Freiburg im Breisgau, Baden-Württemberg, Germany
  • Westermann, Lukas, Universitatsklinikum Freiburg Innere Medizin, Freiburg im Breisgau, Baden-Württemberg, Germany
  • Arnold, Frederic, Universitatsklinikum Freiburg Innere Medizin, Freiburg im Breisgau, Germany
Background

Diabetes mellitus is a major risk factor for the development of chronic kidney disease (CKD). An association between glycated hemoglobin (HbA1c) and decline of kidney function is well established. There is limited data addressing the prognostic value of baseline HbA1c to predict long-term renal outcomes regardless of diabetes status or anti-diabetic therapies.

Methods

In this single-center retrospective observational study, we analyze the effect of glycemic status on renal outcomes in a study population of N = 19,285 subjects over a median follow-up time of 69 months. The primary endpoint was defined as time to manifestation of moderate CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2) in subjects with unconstrained kidney function (eGFR > 60 ml/min/1.73 m2) at baseline. The secondary endpoint was defined as time to progression of CKD (eGFR < 30 ml/min/1.73 m2) in subjects with CKD stage III (eGFR 30 - 60 ml/min/1.73m2) at baseline. Endpoints were individually analyzed using interval- and right-censored datasets. For univariate time-to-event analysis, subjects were grouped into four cohorts by median HbA1c at baseline (HbA1c: < 5.7%, 5.7 – 6.5%, 6.5% – 8.5%, ≥ 8.5%). Covariate-adjusted hazard ratios were estimated applying multivariate parametric regression models on continuous HbA1c measures. A Cox proportional hazard based model was established to predict decline of kidney function based on discrete baseline HbA1c levels.

Results

Lowest baseline HbA1c levels were associated with the slowest decline of kidney function, highest baseline HbA1c levels with the fastest decline of kidney function (median time to primary endpoint for HbA1c < 5.7%: 16 years [95% CI: 13.6-17.8]; for HbA1c 5.7 - 6.5%: 14. years [95% CI: 12.4-15.4]; for HbA1c 6.5 - 8.5%: 9.9 years [95% CI: 8.6-11.7]; for HbA1c > 8.5: 7.1 [95% CI: 5,7 - 8,8], P < 0.0001). Similar trends were observed for the secondary endpoint. Covariate-adjusted time-to-event analysis confirms a concentration-dependent effect of HbA1c at baseline on both endpoints.

Conclusion

HbA1c is a strong predictor for kidney function decline, regardless of preexisting diabetes status or CKD stage. Lower HbA1c levels are associated with a lower risk of manifestation or progression of CKD.

Funding

  • Government Support – Non-U.S.