Can glycated hemoglobin act as a reliable glycemic indicator in patients with diabetic chronic kidney disease? evidence from the Northeast of Thailand
Abstract: Chronic kidney
diseases (CKD) is a common microvascular complication in patients with diabetes
mellitus (DM) which requires adequate glycemic control. Glycated hemoglobin
(HbA1c) is a conventional biomarker to estimate glycemic status, but its role
in diabetic CKD patients is unclear. Therefore, this study aimed to determine
whether patients with high HbA1c are associated to develop diabetic CKD.
Methods: Data were obtained from a clinical registry of diabetic patients
who were treated in a district hospital in the Northeast of Thailand. CKD was
defined according to the estimated glomerular filtration rate
(eGFR<60mL/min/1.73m2). Anthropometric and biochemical measurements of the
patient were taken by review of medical records. Multiple logistic regression
analysis was used to determine the likelihood of the association between HbA1c
and CKD.
Results: Among 4,050 participants, 1,027 (25.3%) developed diabetic CKD.
Older age (adjusted odds ratio (AOR): 4.88, 95% confidence interval (CI):
3.71–6.42, p<0.05), female (AOR: 1.38, 95% CI: 1.05–1.73, p<0.05), and
hypertension (AOR: 1.52, 95% CI: 1.21–1.91, p<0.05) were found as the risk
factors of diabetic CKD. However, patients with high HbA1c (>6.5%) were
negatively associated with diabetic CKD (AOR: 0.66, 95% CI: 0.51–0.86,
p<0.05).
Conclusion: This study found patients with higher HbA1c level were not
associated with diabetic CKD. Therefore, using the conventional cut-off values
of HbA1c in diabetic CKD patients may be problematic in the clinical settings.
Enhanced detection of glycemic status in patients with diabetic CKD is
warranted to improve the outcome.
Keywords: Diabetic CKD; eGFR;
Glycated hemoglobin; Thailand
Author: Sojib Bin Zaman,
Naznin Hossain, Ahmed E. Rahman, Sheikh M.S. Islam
Journal Code: jpkedokterangg170235
