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Association of HbA<sub>1C</sub> Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3–4
oleh: Mei-Yueh Lee, Jiun-Chi Huang, Szu-Chia Chen, Hsin-Ying Clair Chiou, Pei-Yu Wu
Format: | Article |
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Diterbitkan: | MDPI AG 2018-12-01 |
Deskripsi
Little is known about the predictive value of glycosylated hemoglobin (HbA<sub>1C</sub>) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA<sub>1C</sub> variability is associated with progression to end-stage renal disease in diabetic patients with stages 3⁻5 CKD, and whether different stages of CKD affect these associations. Three hundred and eighty-eight patients with diabetes and stages 3⁻5 CKD were enrolled in this longitudinal study. Intra-individual HbA<sub>1C</sub> variability was defined as the standard deviation (SD) of HbA<sub>1C</sub>, and the renal endpoint was defined as commencing dialysis. The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA<sub>1C</sub> SD (tertile 3 vs. tertile 1) and a lower risk of the renal endpoint (hazard ratio = 0.175; 95% confidence interval = 0.059⁻0.518; <i>p</i> = 0.002) in the patients with an HbA<sub>1C</sub> level ≥ 7% and stages 3⁻4 CKD, but not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA<sub>1C</sub> SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA<sub>1C</sub>. Our results demonstrated that greater HbA<sub>1C</sub> variability and a decreasing trend of HbA<sub>1C</sub>, which may be related to intensive diabetes control, was associated with a lower risk of progression to dialysis in the patients with stages 3⁻4 CKD and poor glycemic control (HbA1c ≥ 7%).