Prognostic association of HbA1c and fasting plasma glucose with reduced kidney function in subjects with and without diabetes mellitus. Results from a population-based cohort study from Germany

• Published in: Preventive medicine Vol. 57; no. 5; pp. 596 - 600
• Main Authors: Schöttker, B., Brenner, H., Koenig, W., Müller, H., Rothenbacher, D.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2013; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood glucose; Blood Glucose - metabolism; Cardiovascular diseases; Cohort Studies; Cohort study; Creatinine - blood; Diabetes mellitus, type 2; Diabetes Mellitus, Type 2 - blood; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - blood; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Female; Follow-Up Studies; Germany; Glomerular Filtration Rate - physiology; Glucose; Glucose Tolerance Test; Glycated Hemoglobin A - metabolism; HbA1c; Humans; Internal Medicine; Kidney disease; Kidney diseases; Kidney Function Tests; Kidneys; Male; Medical sciences; Middle Aged; Miscellaneous; Prediabetes; Prediabetic State - blood; Prevention and actions; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Europe; Germany; RR; Blood glucose; Kidney disease; OR; Diabetes mellitus, type 2; IFG; RKF; Prediabetes; Epidemiology; Cohort study; IGT; FPG; OGTT; CKD; HbA1c; BMI; chronic kidney disease; oral glucose tolerance test; Impaired glucose tolerance; Impaired fasting glucose; body mass index; reduced kidney function; Relative risk; HbA 1c; Odds ratio; fasting plasma glucose; glycated hemoglobin A 1c; Endocrinopathy; Human; Urinary system disease; Renal function; Prognosis; Diabetes mellitus; HbA; Glucose; Hemoglobin A1; Statistical study; Result; Reduction; Type; Association; Population; Fast; Glycemia; Public health; glycated hemoglobin A(1c); HbA(1c)
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2013.08.002

To determine the risk for incident reduced kidney function (RKF) of subjects with pre-diabetes (impaired fasting glucose (IFG, 5.6–6.9mmol/L)) or HbA1c-defined pre-diabetes (5.7%–6.4%) and to determine dose–response relationships of fasting glucose and HbA1c with RKF in subjects with manifest diabetes mellitus. In a German population-based cohort, recruited 2000–2002 with ages 50–74years, log-binomial regression was used to estimate relative risks (RR) with 95% confidence intervals (95%CI) and restricted cubic splines to plot dose–response relationships. During 8years of follow-up, 678 of 3538 study participants developed primary RKF. Although RKF risk factor prevalences and RKF incidences were higher in subjects with pre-diabetes than in subjects with normal FPG and/or HbA1c levels, an increased risk did not persist after adjusting for established cardiovascular risk factors (RR(IFG): 0.97 (95% CI: 0.75–1.25) and RR(HbA1c-defined pre-diabetes): 1.03 (95% CI: 0.86–1.23)). In subjects with manifest diabetes, RKF risk increased linearly to a more than three-fold risk with increasing fasting glucose and HbA1c levels (at HbA1c>6.4%). This study provides further evidence that pre-diabetes may not directly contribute to the development of kidney disease. Subjects with pre-diabetes might nevertheless profit from preventive efforts reducing their cardiovascular risk profile because cardiovascular and kidney disease share common risk factors. •Subjects with pre-diabetes showed increased cardiovascular risk factors (CVRF).•Subjects with pre-diabetes had higher incidence of reduced kidney function (RKF).•Pre-diabetes was not predictive for RKF after adjustment for CVRF.•Results were independent from using fasting glucose or HbA1c to define pre-diabetes.•In diabetes patients, RKF risk increased linearly with glucose and HbA1c levels.