Association Between Glycosylated Hemoglobin Level and 16-Year Incidence of Chronic Kidney Disease in Type 1 Diabetes

 

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Abstract

Context: The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes.

Objective: To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes.

Design: Prospective cohort study of type 1 diabetes individuals.

Setting: Community based in southwestern Wisconsin.

Participants: 547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86).

Main Outcome Measures: Development of CKD (defined as estimated glomerular filtration rate<60 ml/min/1.73 m² or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD.

Results: After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trend<0.0001 for incident CKD and 21.87 (2.84-168.39), p-trend<0.0001 for ESRD.

Conclusions: Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.

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1 Confl ict of interest: There are no confl icts of interest related to this manuscript.

Correspondence

A. Shankar

Department of Community

Occupational, and Family Medicine

Yong Loo Lin School of Medicine

National University of Singapore

Block MD3

16 Medical Drive

117597 Singapore

Phone: +65/65/16 49 68

Fax: +65/67/79 14 89

Email: ashankar@nus.edu.sg