Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD
Background The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the Kore...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Diabetes Association
2023-07-01
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| Series: | Diabetes & Metabolism Journal |
| Subjects: | |
| Online Access: | http://e-dmj.org/upload/pdf/dmj-2022-0112.pdf |
| _version_ | 1797755737589415936 |
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| author | Ga Young Heo Hee Byung Koh Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Jayoun Kim Soo Wan Kim Yeong Hoon Kim Su Ah Sung Kook-Hwan Oh Seung Hyeok Han |
| author_facet | Ga Young Heo Hee Byung Koh Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Jayoun Kim Soo Wan Kim Yeong Hoon Kim Su Ah Sung Kook-Hwan Oh Seung Hyeok Han |
| author_sort | Ga Young Heo |
| collection | DOAJ |
| description | Background The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease. Results During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups. Conclusion This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM. |
| first_indexed | 2024-03-12T17:51:31Z |
| format | Article |
| id | doaj.art-63e5e766c7884381928d2366cc6e7d88 |
| institution | Directory Open Access Journal |
| issn | 2233-6079 2233-6087 |
| language | English |
| last_indexed | 2024-03-12T17:51:31Z |
| publishDate | 2023-07-01 |
| publisher | Korean Diabetes Association |
| record_format | Article |
| series | Diabetes & Metabolism Journal |
| spelling | doaj.art-63e5e766c7884381928d2366cc6e7d882023-08-03T04:57:40ZengKorean Diabetes AssociationDiabetes & Metabolism Journal2233-60792233-60872023-07-0147453554610.4093/dmj.2022.01122742Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKDGa Young Heo0Hee Byung Koh1Hyung Woo Kim2Jung Tak Park3Tae-Hyun Yoo4Shin-Wook Kang5Jayoun Kim6Soo Wan Kim7Yeong Hoon Kim8Su Ah Sung9Kook-Hwan Oh10Seung Hyeok Han11 Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, KoreaBackground The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease. Results During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups. Conclusion This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.http://e-dmj.org/upload/pdf/dmj-2022-0112.pdfcardiovascular diseasesdiabetes mellitus, type 2glycated hemoglobin arenal insufficiency, chronic |
| spellingShingle | Ga Young Heo Hee Byung Koh Hyung Woo Kim Jung Tak Park Tae-Hyun Yoo Shin-Wook Kang Jayoun Kim Soo Wan Kim Yeong Hoon Kim Su Ah Sung Kook-Hwan Oh Seung Hyeok Han Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD Diabetes & Metabolism Journal cardiovascular diseases diabetes mellitus, type 2 glycated hemoglobin a renal insufficiency, chronic |
| title | Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD |
| title_full | Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD |
| title_fullStr | Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD |
| title_full_unstemmed | Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD |
| title_short | Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD |
| title_sort | glycemic control and adverse clinical outcomes in patients with chronic kidney disease and type 2 diabetes mellitus results from know ckd |
| topic | cardiovascular diseases diabetes mellitus, type 2 glycated hemoglobin a renal insufficiency, chronic |
| url | http://e-dmj.org/upload/pdf/dmj-2022-0112.pdf |
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