Impact of HbA1c reduction on major kidney outcomes in type 2 diabetes with poor glycemic control and advanced CKD
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Fecha
2025
Autores
Navarro Blackaller, Guillermo
Benitez-Renteria, A. S.
Hernández-Morales, K.
Rico-Fontalvo, Jorge
Daza-Arnedo, R.
Gómez-Ramírez, G. G.
Camacho-Guerrero, J. R.
Pérez-Venegas, M. A.
Carmona-Morales, J.
Oseguera-González, A. N.
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Wiley
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Aims: In subjects with type 2 diabetes (DM), poor glycemic control, and advanced chronic kidney disease (CKD), the kidney
beneft of the reduction of glycated hemoglobin (HbA1c) is not well established.
Methods: In a retrospective cohort, we included patients with DM, CKD grade 3b-5, and HbA1c > 9% to evaluate the risk of
developing major adverse kidney events (MAKE) defned as the start of kidney replacement therapy (KRT), ≥ 25% or ≥ 40%
decline in the glomerular fltration rate (eGFR) from baseline, and death; patients were divided according to the HbA1c levels at
the end of the follow-up into the following groups: > 75 mmol/mol (≥ 9.0%), 74–64 mmol/mol (8.9%–8.0%), 64–53 mmol/mol
(7.9%–7.0%), and < 52 mmol/mol (< 7.0%). We described their characteristics and analyzed their risks, adjusting for confounding
variables.
Results: From 2015 to 2023, 111 patients were included. In 46 patients (41.4%), the HbA1c at the end of follow-up (60 months) was
still > 75 mmol/mol (≥ 9%), and each patient had a mean of 4.9 HbA1c measurements. Te mean age was 59 years, and 46% were
male; the baseline eGFR was 25 mL/min/1.73 m2
. MAKE occurred in 67% of cases. In a multivariate analysis, the risk of MAKE
was not associated with the HbA1c groups, nor was it associated with any of the MAKE components individually, nor in certain
subgroups. When evaluating the magnitude of percentage changes in HbA1 with the initiation of KRT, we did not fnd any
association.
Conclusions: With advanced CKD and poor glycemic control, changes in HbA1c during long follow-up are not associated with
MAKE or its individual components.
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Navarro-Blackaller, G., Benitez-Renteria, A. S., Hernández-Morales, K., Rico-Fontalvo, J., Daza-Arnedo, R., Gómez-Ramírez, G. G., Camacho-Guerrero, J. R., Pérez-Venegas, M. A., Carmona-Morales, J., Oseguera-González, A. N., Murguía-Soto, C., Chávez-Alonso, G., García-Peña, F., Barrera-Torres, C. J., Orozco-Chan, E., Arredondo-Dubois, M., Gallardo-González, A. Martínez, Gómez-Fregoso, J. A., Rodríguez-García, F. G., Luquin-Arellano, V. H., Abundis-Mora, G., Alcantar-Vallin, L., Medina-González, R., García-García, G., Chávez-Iñiguez, J. S., Impact of HbA1c Reduction on Major Kidney Outcomes in Type 2 Diabetes With Poor Glycemic Control and Advanced CKD, International Journal of Endocrinology, 2025, 9919963, 12 pages, 2025. https://doi.org/10.1155/ije/9919963
