Department of Nephrology, Seoul National University Bundang Hospital, Kyeong-Kido, South Korea.
Nephrol Dial Transplant. 2011 Jul;26(7):2238-44. doi: 10.1093/ndt/gfq707. Epub 2010 Nov 23.
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.
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.
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).
HbA(1c) < 6.50% was associated with reduced development of ESRD in all patients and later stages of chronic kidney disease.
糖化血红蛋白（HbA(1c)）与糖尿病患者终末期肾病（ESRD）发病率之间的关系尚不确定，尤其是在肾小球滤过率（GFR）下降的患者中。本研究旨在评估 HbA(1c)的适当水平，以最大程度地降低 ESRD 和全因死亡率的发生。
从首尔国立大学盆唐医院数据库中生成了一个年龄在 25 岁及以上、在 2004 年接受过糖尿病治疗的患者队列，使用诊断代码和处方药物进行筛选。根据 2004 年基线 HbA(1c)，将 4474 例患者分为三组（HbA(1c) < 6.50%、6.50-7.49%和 ≥ 7.50%；分别命名为组 1、组 2 和组 3）。结局从韩国统计数据库中提取，用于死亡率分析，从韩国肾脏病学会登记处提取 ESRD 发病率数据。
在平均 5.29 ± 1.22 年的随访期间，90 例患者发生 ESRD。组 1 的 ESRD 发生率最低（P = 0.003）。与组 1 相比，组 2 和组 3 的 ESRD 调整后风险比分别为 2.915 和 4.219。与 HbA(1c) < 6.50%的患者相比，HbA(1c) ≥ 6.50%的患者无论 GFR 如何，其 ESRD 发生率均升高。然而，对于年龄大于 80 岁和糖尿病病程大于 10 年的患者，HbA(1c) < 6.50%并不能降低 ESRD 的发生风险。全因死亡率与 HbA(1c)水平无关。
HbA(1c) < 6.50%与所有患者和慢性肾脏病晚期 ESRD 的发生减少相关。
