Hung Chi-Chih, Zhen Yen-Yi, Niu Sheng-Wen, Lin Kun-Der, Lin Hugo You-Hsien, Lee Jia-Jung, Chang Jer-Ming, Kuo I-Ching
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan.
Biomedicines. 2022 Aug 2;10(8):1858. doi: 10.3390/biomedicines10081858.
Glycated hemoglobin (HbA1c) levels are commonly used to indicate long-term glycemic control. An HbA1c level of 6.5−5.7% is defined as pre-diabetes and is proposed as a criterion for diagnosing metabolic syndrome (MetS). However, HbA1c levels can be affected by chronic kidney disease (CKD). Whether HbA1c is associated with clinical outcomes in nondiabetic CKD patients with or without MetS is still unknown. This study included 1270 nondiabetic CKD stage 1−4 Asian patients, divided by HbA1c and MetS. Through linear regression, HbA1c was positively associated with age, waist circumference, hemoglobin levels, and C-reactive protein and was negatively associated with malnutrition−inflammation. HbA1c levels were 5.5% (0.6%) and 5.7% (0.6%) in non-MetS and MetS, respectively (p < 0.001). In Cox regression, higher-level HbA1c was associated with worse composite renal outcome in MetS patients, but with better renal outcome in non-MetS patients: Hazard ratio (HR) (95% confidence interval [CI]) of HbA1c ≥5.7%, compared with HbA1c <5%, was 2.00 (1.06−3.78) in MetS and 0.25 (0.14−0.45) in non-MetS. An association between HbA1c and all-cause mortality was not found. In conclusion, higher HbA1c levels are associated with worse renal outcomes in nondiabetic CKD stage 1−4 patients modified by the presence of MetS.
糖化血红蛋白（HbA1c）水平通常用于指示长期血糖控制情况。HbA1c水平在6.5%至5.7%之间被定义为糖尿病前期，并被提议作为诊断代谢综合征（MetS）的标准。然而，HbA1c水平可能会受到慢性肾脏病（CKD）的影响。在患有或未患有MetS的非糖尿病CKD患者中，HbA1c是否与临床结局相关仍不清楚。本研究纳入了1270例1-4期非糖尿病亚洲CKD患者，根据HbA1c和MetS进行分组。通过线性回归分析，HbA1c与年龄、腰围、血红蛋白水平和C反应蛋白呈正相关，与营养不良-炎症呈负相关。非MetS组和MetS组的HbA1c水平分别为5.5%（0.6%）和5.7%（0.6%）（p<0.001）。在Cox回归分析中发现，较高水平的HbA1c与MetS患者较差的综合肾脏结局相关，但与非MetS患者较好的肾脏结局相关：与HbA1c<5%相比，HbA1c≥5.7%的风险比（HR）（95%置信区间[CI]）在MetS组为2.00（1.06-3.78），在非MetS组为0.25（0.14-0.45）。未发现HbA1c与全因死亡率之间存在关联。总之，在1-4期非糖尿病CKD患者中，较高的HbA1c水平与MetS存在与否所导致的较差肾脏结局相关。
