Kidney Week

Abstract: SA-PO162

Anemia Modifies the Associations Between Hemoglobin A1c and Outcomes in CKD

Session Information

• Diabetic Kidney Disease: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Jung, Molly, Johns Hopkins University, Baltimore, California, United States

Molly Jung,

• Selvin, Elizabeth, Johns Hopkins University, Baltimore, Maryland, United States

Elizabeth Selvin,

• Rebholz, Casey, Johns Hopkins University, Baltimore, Maryland, United States

Casey Rebholz,

• Lee, Clare, Johns Hopkins University, Baltimore, Maryland, United States

Clare Lee,

• Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States

Jing Chen,

• He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Jiang He,

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu,

• Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

James P. Lash,

• Mohanty, Madhumita J., Wayne State University, Detroit, Michigan, United States

Madhumita J. Mohanty,

• Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States

Sankar D. Navaneethan,

• Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States

Sylvia E. Rosas,

• Spanakis, Elias, University of Maryland, Baltimore, Maryland, United States

Elias Spanakis,

• Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir,

• Shafi, Tariq, Johns Hopkins University, Baltimore, Maryland, United States

Tariq Shafi,

Background

CKD and diabetes commonly co-occur. However, glycemic control and glycemic targets in these patients remain undefined.

Methods

In 1,833 participants of the Chronic Renal Insufficiency Cohort with diabetes, we assessed the association between baseline hemoglobin A1c (A1c) and death, first cardiovascular disease (CVD) event, and CKD progression using multivariable-adjusted Cox models. We also investigated: a) effect modification by anemia, eGFR, or albuminuria; and b) linearity of the association using spline models.

Results

At baseline, mean age was 59 years, mean eGFR was 41 mL/min/1.73 m2, mean A1c was 7.6%, and mean hemoglobin was 12 g/dL. During a median 6 years of follow-up, higher A1c was associated with worse outcomes (Figure 1); risk per 1% higher A1c was 10% for death, 10% for CVD events, and 5% for CKD progression. Anemia (hemoglobin<11 g/dL) was associated with non-linear associations for all three outcomes (Figure 2). A1c was associated with CKD progression in patients with eGFR≥30 ml/min/1.73m2 but not below that level. There was no effect modification by albuminuria.

Conclusion

In patients with CKD and diabetes, poor glycemic control contributes to a higher risk of death and CVD events. Individualized A1c targets and/or alternative markers of glycemia may be useful in diabetic CKD patients with anemia.

Funding

• Other NIH Support