Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study

TY - JOUR

T1 - Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: Retrospective cohort study

AU - Habte-Asres, Hellena

AU - Murrells, Trevor

AU - Nitsch, Dorothea

AU - Wheeler, David C.

AU - Forbes, Angus

N1 - Funding Information: The authors received no funding from an external source. Publisher Copyright: © 2022

PY - 2022/11

Y1 - 2022/11

N2 - Aim To investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease. Methods A cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis. Results There were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD ± 9.2), and a mean baseline eGFR 40.7 (±10.7) ml/min/1.73 m2. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95 %CI) for each variability score group, were as follows: 21–40, 1.38 (1.27–1.50); 41–60, 1.54 (1.41–1.68); 61–80, 1.61 (1.45–1.79); and 81–100, 1.42 (1.19–1.68), compared with the group (score 0–20) with least variability. The adjusted sHR for CV were as follows: 6.7–9.9, 1.29 (1.15–1.45); 10.0–13.9, 1.55 (1.39–1.74); 14.0–20.1, 1.79 (1.60–2.01) and ≥20.2, 2.10 (1.88–2.34) compared to reference group 0–6.6. Conclusions Glycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.

AB - Aim To investigate the association between glycaemic variability and the development of End-Stage-Kidney-Disease (ESKD) among individuals with diabetes and chronic kidney disease. Methods A cohort study using UK electronic primary care health records from the Clinical Practice Research Datalink. Glycaemic variability was assessed using a variability score and intra-individual coefficient of variation (CV) of HbA1c. We calculated sub-distribution hazard ratios (sHR) for developing ESKD using competing risk regression analysis. Results There were 37,222 eligible participants (45.5 % male), with a mean age of 76.4 years (SD ± 9.2), and a mean baseline eGFR 40.7 (±10.7) ml/min/1.73 m2. There were 5,086 incidents of ESKD in the follow-up period. The adjusted sHR (95 %CI) for each variability score group, were as follows: 21–40, 1.38 (1.27–1.50); 41–60, 1.54 (1.41–1.68); 61–80, 1.61 (1.45–1.79); and 81–100, 1.42 (1.19–1.68), compared with the group (score 0–20) with least variability. The adjusted sHR for CV were as follows: 6.7–9.9, 1.29 (1.15–1.45); 10.0–13.9, 1.55 (1.39–1.74); 14.0–20.1, 1.79 (1.60–2.01) and ≥20.2, 2.10 (1.88–2.34) compared to reference group 0–6.6. Conclusions Glycaemic variability was strongly associated with the development of ESKD in people with diabetes and CKD.

KW - Glycaemic variability HbA1c variability Diabetes nephropathy Chronic kidney disease End-stage kidney disease Microvascular complication

KW - Kidney Failure, Chronic

UR - https://www.scopus.com/pages/publications/85140299912

U2 - 10.1016/j.diabres.2022.110117

DO - 10.1016/j.diabres.2022.110117

M3 - Article

SN - 0168-8227

VL - 193

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

IS - 110117

M1 - 110117

ER -