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

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.

Key words

type 1 diabetes - epidemiology - glycemic control - chronic kidney disease - CKD - ESRD

References

• 1 Klein R, Klein BE, Moss S, DeMets DL. Proteinuria in diabetes.  Arch Intern Med. 1988;  148 181-186
• 2 Klein R, Klein BE, Linton KL, Moss SE. Microalbuminuria in a population-based study of diabetes.  Arch Intern Med. 1992;  152 153-158
• 3 Klein R, Klein BE, Moss SE, Cruickshanks KJ. Ten-year incidence of gross proteinuria in people with diabetes.  Diabetes. 1995;  44 916-923
• 4 Krolewski AS, Laffel LM, Krolewski M, Quinn M, Warram JH. Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus.  N Engl J Med. 1995;  332 1251-1255
• 5 Rossing P, Rossing K, Jacobsen P, Parving HH. Unchanged incidence of diabetic nephropathy in IDDM patients.  Diabetes. 1995;  44 739-743
• 6 Orchard TJ, Dorman JS, Maser RE. et al . Factors associated with avoidance of severe complications after 25 yr of IDDM. Pittsburgh Epidemiology of Diabetes Complications Study I.  Diabetes Care. 1990;  13 741-747
• 7 Chase HP, Jackson WE, Hoops SL, Cockerham RS, Archer PG, O’Brien D. Glucose control and the renal and retinal complications of insulin-dependent diabetes.  JAMA. 1989;  261 1155-1160
• 8 Feldt-Rasmussen B, Mathiesen ER, Deckert T. Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes.  Lancet. 1986;  2 1300-1304
• 9 The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group.  N Engl J Med. 1993;  329 977-986
• 10 Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.  N Engl J Med. 1993;  329 304-309
• 11 Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group.  Kidney Int. 1995;  47 1703-1720
• 12 Klein R, Klein BE, Moss SE, Cruickshanks KJ, Brazy PC. The 10-year incidence of renal insufficiency in people with type 1 diabetes.  Diabetes Care. 1999;  22 743-751
• 13 Ueda H, Ishimura E, Shoji T. et al . Factors affecting progression of renal failure in patients with type 2 diabetes.  Diabetes Care. 2003;  26 1530-1534
• 14 Hovind P, Rossing P, Tarnow L, Smidt UM, Parving HH. Progression of diabetic nephropathy.  Kidney Int. 2001;  59 702-709
• 15 Breyer JA, Bain RP, Evans JK. et al . Predictors of the progression of renal insufficiency in patients with insulin-dependent diabetes and overt diabetic nephropathy. The Collaborative Study Group.  Kidney Int. 1996;  50 1651-1658
• 16 Krolewski M, Eggers PW, Warram JH. Magnitude of end-stage renal disease in IDDM: a 35 year follow-up study.  Kidney Int. 1996;  50 2041-2046
• 17 Feest TG, Dunn EJ, Burton CJ. Can intensive treatment alter the progress of established diabetic nephropathy to end-stage renal failure?.  QJM. 1999;  92 275-282
• 18 K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.  Am J Kidney Dis. 2002;  39 ((2 Suppl 1)) S1-266
• 19 Klein R, Klein BE, Moss SE, DeMets DL, Kaufman I, Voss PS. Prevalence of diabetes mellitus in southern Wisconsin.  Am J Epidemiol. 1984;  119 54-61
• 20 Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years.  Arch Ophthalmol. 1984;  102 520-526
• 21 Klein R, Moss SE, Klein BE, Davis MD, DeMets DL. Wisconsin epidemiologic study of diabetic retinopathy. XII. Relationship of C-peptide and diabetic retinopathy.  Diabetes. 1990;  39 1445-1450
• 22 Moss SE, Klein R, Klein BE, Spennetta TL, Shrago ES. Methodologic considerations in measuring glycosylated hemoglobin in epidemiologic studies.  J Clin Epidemiol. 1988;  41 645-649
• 23 Klein R, Moss S. Diabetes Control and Complications Trial Research Group . A comparison of the study populations in the diabetes control and complications trial and the wisconsin epidemiologic study of diabetic retinopathy.  Arch Intern Med. 1995;  155 745-754
• 24 The hypertension detection and follow-up program: hypertension detection and follow-up program cooperative group.  Prev Med. 1976;  5 207-215
• 25 Poggio ED, Wang X, Greene T, Van LF, Hall PM. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease.  J Am Soc Nephrol. 2005;  16 459-466
• 26 Rigalleau V, Lasseur C, Raffaitin C. et al . Glucose control influences glomerular filtration rate and its prediction in diabetic subjects.  Diabetes Care. 2006;  29 1491-1495
• 27 Alberti C, Metivier F, Landais P, Thervet E, Legendre C, Chevret S. Improving estimates of event incidence over time in populations exposed to other events: application to three large databases.  J Clin Epidemiol. 2003;  56 536-545
• 28 Hosmer DW, Lemeshow S. Applied logistic regression (pages 238-245), ISBN 0471615536. New York: Wiley 1989
• 29 Coresh J, Astor BC, McQuillan G. et al . Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate.  Am J Kidney Dis. 2002;  39 920-929
• 30 Standards of medical care for patients with diabetes mellitus.  Diabetes Care. 2003;  26 ((Suppl 1)) S33-S50

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

Correspondence