Glycated haemoglobin and the incidence of end-stage renal disease in diabetics
Glycated haemoglobin and the incidence of end-stage renal disease in diabetics
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DOI：
10.1093/ndt/gfq707
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发表时间：
2011-07-01
影响因子：
6.1
通讯作者：
Chin, Ho Jun
中科院分区：
文献类型：
--
作者：
Oh, Se Won;Kim, Yong Chul;Chin, Ho Jun
背景。糖化血红蛋白与糖尿病患者终末期肾病（ESRD）发病率之间的关系仍不确定，特别是在肾小球滤过率（GFR）降低的患者中。本研究的目的是评估糖尿病患者适当的HbA（1c）水平，以尽量减少ESRD的发生率和全因死亡率。在2004年期间，使用诊断代码和处方药物从首尔国立大学盆唐医院数据库中生成了一组年龄在25岁或以上的糖尿病患者。4474例患者根据2004年基线HbA（1c）分为三组(HbA(1c) < 6.50%, 6.50-7.49%和>= 7.50%；分别称为1、2和3组)。结果提取自韩国统计死亡率数据库和韩国肾脏学会ESRD发病率登记处。90例患者在5.29 +/- 1.22年平均随访期间发生ESRD。组1患者ESRD发生率最低（P = 0.003）。与本组比较，2、3组ESRD调整后的风险比分别为2.915、4.219。与GFR无关，HbA(1c) = 6.50%的患者与HbA(1c) < 6.50%的患者相比，ESRD的发生率增加。然而，HbA(1c) < 6.50%对80岁以上患者和糖尿病病程bb10年患者的ESRD发展无益处。全因死亡率与HbA（1c）水平无关。在所有患者和晚期慢性肾脏疾病中，HbA(1c) bb0 6.50%与ESRD的发展减少相关。
Background. The relationship between glycated haemoglobin and the incidence of end-stage renal disease (ESRD) in patients with diabetes remains uncertain, especially in those with decreased glomerular filtration rate (GFR). The aim of this study was to assess the appropriate HbA(1c) level for diabetics for minimizing the incidence of ESRD and all-cause mortality.Methods. A cohort of patients aged 25 years or older who had been treated for diabetes was generated from the Seoul National University Bundang Hospital database using diagnosis code and prescribed medication during 2004. The 4474 patients were classified into three groups according to the baseline HbA(1c) in 2004 (HbA(1c) < 6.50%, 6.50-7.49% and >= 7.50%; termed groups 1, 2 and 3, respectively). The outcomes were extracted from the database of Statistics Korea for mortality and registry in the Korean Society of Nephrology for ESRD incidence.Results. Ninety patients developed ESRD during 5.29 +/- 1.22 years of mean follow-up period. Group 1 patients showed the lowest incidence of ESRD (P = 0.003). Compared with this group, the adjusted hazard ratio of ESRD was 2.915 and 4.219 in groups 2 and 3, respectively. The incidence of ESRD increased in patients with HbA(1c) = 6.50% compared with the patients with HbA(1c) < 6.50%, regardless of GFR. However, HbA(1c) < 6.50% showed no benefit on ESRD development in patients older than 80 years and in patients with diabetic duration > 10 years. All-cause mortality was not associated with the level of HbA(1c).Conclusions. HbA(1c) > 6.50% was associated with reduced development of ESRD in all patients and later stages of chronic kidney disease.