Kofod Dea H, Carlson Nicholas, Almdal Thomas P, Bomholt Tobias, Torp-Pedersen Christian, Nørgaard Kirsten, Svendsen Jesper H, Feldt-Rasmussen Bo, Hornum Mads
Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Diabetes Care. 2025 Aug 1;48(8):1400-1409. doi: 10.2337/dc25-0339.
The optimal glycemic target for individuals with severe chronic kidney disease (CKD) remains unclear. We investigated the association between HbA1c and complications in individuals with diabetes and severe CKD.
In a Danish nationwide registry-based cohort study, we included 27,113 individuals ≥18 years old with diabetes and severe CKD (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) between 2010 and 2022. As reference groups, we included an age- and sex-matched cohort of 80,131 individuals with diabetes and mild-to-moderate CKD (eGFR 30-59 mL/min/1.73 m2) and 80,797 individuals with diabetes and no-to-mild CKD (eGFR ≥60 mL/min/1.73 m2). Multiple Cox regressions were used to estimate the standardized 1-year risk of major adverse cardiovascular events (MACE), microvascular complications, and hospitalizations due to hypoglycemia across strata of HbA1c levels.
For individuals with severe CKD, the risk of MACE significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.01) and <5.8% (40 mmol/mol) (P < 0.001), compared with an HbA1c level of 6.3-6.6% (45-49 mmol/mol). The risk of microvascular complications significantly increased at HbA1c levels ≥7.2% (55 mmol/mol) (P < 0.001), and the risk of hospitalization due to hypoglycemia significantly increased at HbA1c levels ≥6.7% (50 mmol/mol) (P < 0.001). The association patterns between HbA1c and outcomes were similar in the severe CKD cohort compared with the matched cohorts with mild-to-moderate CKD and no-to-mild CKD.
Our data suggest an HbA1c range of 6.7-7.1% (50-54 mmol/mol) to be most favorable for reducing long-term complications in this high-risk population.
重度慢性肾脏病（CKD）患者的最佳血糖目标仍不明确。我们调查了糖尿病合并重度CKD患者糖化血红蛋白（HbA1c）与并发症之间的关联。
在一项基于丹麦全国登记处的队列研究中，我们纳入了2010年至2022年间年龄≥18岁的27113例糖尿病合并重度CKD患者（估计肾小球滤过率[eGFR]<30 mL/min/1.73 m²）。作为参照组，我们纳入了年龄和性别匹配的80131例糖尿病合并轻至中度CKD患者（eGFR 30 - 59 mL/min/1.73 m²）队列以及80797例糖尿病合并无至轻度CKD患者（eGFR≥60 mL/min/1.73 m²）队列。采用多重Cox回归分析来估计HbA1c水平各分层中主要不良心血管事件（MACE）、微血管并发症以及低血糖导致的住院的标准化1年风险。
对于重度CKD患者，与HbA1c水平为6.3 - 6.6%（45 - 49 mmol/mol）相比，HbA1c水平≥7.2%（55 mmol/mol）（P<0.01）和<5.8%（40 mmol/mol）（P<0.001）时，MACE风险显著增加。HbA1c水平≥7.2%（55 mmol/mol）时，微血管并发症风险显著增加（P<0.001），HbA1c水平≥6.7%（50 mmol/mol）时，低血糖导致的住院风险显著增加（P<0.001）。与匹配的轻至中度CKD队列和无至轻度CKD队列相比，重度CKD队列中HbA1c与结局之间的关联模式相似。
我们的数据表明，HbA1c范围为6.7 - 7.1%（50 - 54 mmol/mol）对降低这一高危人群的长期并发症最为有利。
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