Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Kidney Dis. 2024 Sep;84(3):329-338. doi: 10.1053/j.ajkd.2024.02.006. Epub 2024 Mar 20.
RATIONALE & OBJECTIVE: Hemoglobin A (HbA) is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis-dependent CKD population remains unknown.
Prospective cohort study.
SETTING & PARTICIPANTS: 3,110 participants with CKD from the Chronic Renal Insufficiency Cohort study.
Baseline GA levels.
Incident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality.
Cox proportional hazards regression.
Participant characteristics included mean age 59.0±10.8 SD years; 1,357 (43.6%) female; and 1,550 (49.8%) with diabetes. The median GA was 18.7% (IQR, 15.8%-23.3%). During an average 7.9-year follow-up, there were 980 ESKD events, 968 CVD events, and 1,084 deaths. Higher GA levels were associated with greater risks of all outcomes, regardless of diabetes status: hazard ratios for ESKD, CVD, and death among participants with the highest quartile compared with quartile 2 (reference) were 1.42 (95% CI, 1.19-1.69), 1.67 (95% CI, 1.39-2.01), and 1.63 (95% CI, 1.37-1.94), respectively. The associations with CVD and death appeared J-shaped, with increased risk also seen at the lowest GA levels. Among patients with coexisting CKD and diabetes, the associations of GA with outcomes remained significant even after adjusting for HbA. For each outcome, we observed a significant increase in the fraction of new prognostic information when both GA and HbA were added to models.
Lack of longitudinal GA measurements; and HbA measurements were largely unavailable in participants without diabetes.
Among patients with CKD, GA levels were independently associated with risks of ESKD, CVD, and mortality, regardless of diabetes status. GA added prognostic value to HbA among patients with coexisting CKD and diabetes.
PLAIN-LANGUAGE SUMMARY: Hemoglobin A (HbA) is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis-dependent CKD population remains unknown. In this cohort study of 3,110 individuals with non-dialysis-dependent CKD, GA levels were independently associated with risks of end-stage kidney disease, cardiovascular disease (CVD), and mortality. The associations with CVD and mortality appeared to be J-shaped. Among patients with coexisting CKD and diabetes, GA added prognostic value to HbA Thus, GA may be a valuable complementary test to HbA in patients with CKD.
血红蛋白 A（HbA）被广泛用于估计血糖，但在慢性肾脏病（CKD）患者中不太可靠。人们越来越感兴趣地将糖化白蛋白（GA）补充用于改善血糖监测和风险分层。然而，GA 在非透析依赖性 CKD 人群中的临床结局是否相关仍不清楚。
前瞻性队列研究。
来自慢性肾功能不全队列研究的 3110 例 CKD 患者。
基线 GA 水平。
终末期肾病（ESKD）、心血管疾病（CVD）事件和全因死亡率。
Cox 比例风险回归。
参与者的特征包括平均年龄 59.0±10.8 标准差岁；1357 名（43.6%）女性；1550 名（49.8%）患有糖尿病。GA 的中位数为 18.7%（IQR，15.8%-23.3%）。在平均 7.9 年的随访期间，发生了 980 例 ESKD 事件、968 例 CVD 事件和 1084 例死亡。无论糖尿病状态如何，GA 水平越高，所有结局的风险越高：与四分位 2（参考）相比，四分位 4 的 ESKD、CVD 和死亡的危险比分别为 1.42（95%CI，1.19-1.69）、1.67（95%CI，1.39-2.01）和 1.63（95%CI，1.37-1.94）。与 CVD 和死亡的关联呈 J 形，GA 水平最低时风险也增加。在患有 CKD 和糖尿病的患者中，即使调整了 HbA，GA 与结局的关联仍然显著。对于每个结局，我们观察到当同时将 GA 和 HbA 添加到模型中时，新的预后信息分数显著增加。
缺乏纵向 GA 测量；并且在没有糖尿病的参与者中，HbA 测量基本上不可用。
在 CKD 患者中，GA 水平与 ESKD、CVD 和死亡率的风险独立相关，无论糖尿病状态如何。GA 在患有并存 CKD 和糖尿病的患者中为 HbA 提供了额外的预后价值。
