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Abstract: TH-OR51

Glycated Albumin and Adverse Clinical Outcomes in Patients with CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Tang, Mengyao, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Berg, Anders H., Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Rhee, Eugene P., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Karumanchi, S. Ananth, Cedars-Sinai Medical Center, Los Angeles, California, United States
  • Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

HbA1c is widely used to estimate glycemia, yet it is less reliable in patients with CKD. There is growing interest in complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification in this population. However, whether GA associates with long-term clinical outcomes in a non-dialysis dependent CKD population has not been investigated.

Methods

To determine the prognostic value of GA, we measured baseline serum GA levels in 3110 patients with CKD stages 2–4 enrolled in the prospective Chronic Renal Insufficiency Cohort study. Outcomes include 1) incident ESKD (requiring chronic dialysis or kidney transplant); 2) CVD events (a composite of myocardial infarction, congestive heart failure or stroke); and 3) all-cause mortality.

Results

Participant characteristics included mean age 59 (SD 10.8) years; 1357 (43.6%) female; 1550 (49.8%) with diabetes. The median GA was 18.7 (interquartile range, 15.8-23.3)%. During an average 7.9-year follow-up, there were 980 ESKD events, 968 CVD events, and 1084 deaths. In multivariable adjusted Cox models, higher GA levels were associated with greater risks of all outcomes in patients with CKD, regardless of diabetes status (Fig 1): hazard ratios for ESKD, CVD, and death among participants with the highest quartile compared with quartile 2 (reference) were 1.42 (95% CI, 1.19-1.69), 1.67 (CI, 1.39-2.01), and 1.63 (CI, 1.37-1.94), respectively. The associations with CVD and death appeared J-shaped, with increased risk also seen at the lowest GA levels (quartile 1 vs. reference). Among patients with coexisting CKD and diabetes, the associations of GA with outcomes remained statistically significant even after adjustment for HbA1c. For each outcome, we observed a significant fraction of new prognostic information when both GA and HbA1c were added to models.

Conclusion

Among patients with CKD, GA levels were independently associated with risks of ESKD, CVD, and mortality, regardless of diabetes status. GA added prognostic value to HbA1c among patients with coexisting CKD and diabetes.

Fig 1. Adjusted HRs for GA Levels and Risks of ESKD, CVD and Death.

Funding

  • NIDDK Support