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10-29-2020 | Nephropathy | News

Improving glycemic control may reduce AKI risk in people with type 2 diabetes, CKD

Author: Alba Ruzafa


medwireNews: Poor glycemic control is associated with acute kidney injury (AKI) risk in people with type 2 diabetes and chronic kidney disease (CKD), according to results from an observational study.

“Our findings provide evidence to consider HbA1c [glycated hemoglobin] control for patients with CKD at high risk of AKI,” say Yang Xu (Karolinska Institutet, Stockholm, Sweden) and fellow researchers.

The research focused on adults with type 2 diabetes and confirmed CKD stages G3–G5 who were undergoing routine care at one of two different healthcare systems in the USA and Sweden. The US cohort was built with data from 22,877 patients aged a median of 72 years (55% women) who attended inpatient and outpatient clinics from 1997 to 2019, while the Swedish cohort used the SCREAM project to obtain data from 12,157 patients attending clinics from 2006 to 2011; the median age was 77 years and 51% were women.

After a median follow up of 3.1 years in the US cohort and 2.3 years in the Swedish cohort, 7060 and 2619 AKI events were identified, respectively.

When the investigators classified patients into quintiles of glycemic control intensity according to HbA1c level, they found that “higher HbA1c categories were associated with higher AKI risk” compared with the reference category of 6.0–6.9% (42–52 mmol/mol).

In particular, baseline HbA1c levels of at least 9.0% (75 mmol/mol) were associated with a significantly increased risk for AKI in both the US and the Swedish cohorts, at adjusted hazard ratios (aHR) of 1.29 and 1.33, respectively, when accounting for covariates such as age, sex, diabetic retinopathy, and diabetic neuropathy. US patients with HbA1c levels of 8.0–8.9% (64–74 mmol/mol) also had a significantly increased risk for AKI (aHR=1.16), but this increased risk was not significant for patients in the Swedish cohort. Analysis with restricted cubic splines showed that the association between baseline HbA1c as a continuous variable and the risk for AKI was J-shaped, “with both low and high baseline HbA1c levels being associated with higher AKI risk.”

When using time-varying HbA1c, the association with AKI risk was consistent with the baseline HbA1c analysis.

Xu and co-authors also found a significant association between baseline HbA1c and mortality in both cohorts, and in accordance with the AKI results, time-varying HbA1c “analyses showed associations consistent with our baseline HbA1c analysis,” they note in Diabetes Care.

“Because AKI is common and a strong risk factor for progression of CKD and mortality, our results should be followed by investigations as to whether tighter control of hyperglycemia might reduce risk of AKI,” conclude the investigators.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2020; doi:10.2337/dc20-1588


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