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- Title
Variability in HbA1c, blood pressure, lipid parameters and serum uric acid, and risk of development of chronic kidney disease in type 2 diabetes.
- Authors
Ceriello, Antonio; De Cosmo, Salvatore; Rossi, Maria Chiara; Lucisano, Giuseppe; Genovese, Stefano; Pontremoli, Roberto; Fioretto, Paola; Giorda, Carlo; Pacilli, Antonio; Viazzi, Francesca; Russo, Giuseppina; Nicolucci, Antonio
- Abstract
Aim Variability in HbA1c and blood pressure is associated with the risk of diabetic kidney disease ( DKD). No evidence exists on the role of variability in lipids or serum uric acid ( UA), or the interplay between the variability of different parameters, in renal outcomes. Methods Within the AMD Annals database, we identified patients with ≥5 measurements of HbA1c, systolic blood pressure ( SBP) and diastolic blood pressure ( DBP), total-, high-density lipoprotein ( HDL)- and low-density lipoprotein ( LDL)-cholesterol, triglycerides, and UA. Patients were followed-up for up to 5 years. The impact of measures of variability on the risk of DKD was investigated by Cox regression analysis and recursive partitioning techniques. Results Four-thousand, two-hundred and thirty-one patients were evaluated for development of albuminuria, and 7560 for decreased estimated glomerular filtration rate ( eGFR; <60 mL/min/1.73 m2). A significantly higher risk of developing albuminuria was associated with variability in HbA1c [upper quartile hazard ratio ( HR) = 1.3; 95% confidence interval ( CI) 1.1-1.6]. Variability in SBP, DBP, HDL-C, LDL-C and UA predicted the decline in eGFR, the association with UA variability being particularly strong (upper quartile HR = 1.8; 95% CI 1.3-2.4). The concomitance of high variability in HbA1c and HDL-C conferred the highest risk of developing albuminuria ( HR = 1.47; 95% CI 1.17-1.84), while a high variability in UA ( HR = 1.54; 95% CI 1.19-1.99) or DBP ( HR = 1.47; 95% CI 1.11-1.94) conferred the highest risk of decline in eGFR. Conclusion The variability of several parameters influences the development of DKD, having a different impact on albuminuria development and on the decline in GFR.
- Subjects
DIABETIC nephropathies; URIC acid; BLOOD pressure; GLYCOSYLATED hemoglobin; TYPE 2 diabetes; ALBUMINURIA; GLOMERULAR filtration rate; LOW density lipoproteins; DISEASE risk factors
- Publication
Diabetes, Obesity & Metabolism, 2017, Vol 19, Issue 11, p1570
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.12976