Ren Jiaxin, Wang Ge, Zhou Yizhe, Gong Wei, Zhang Hongjia, Yan Yan
Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Ren Fail. 2025 Dec;47(1):2549412. doi: 10.1080/0886022X.2025.2549412. Epub 2025 Sep 3.
To validate the effectiveness of intensive glycemic control in preventing acute kidney injury (AKI) among patients with coronary artery disease (CAD) and prediabetes.
This investigation employed data from the Prospective Registry of the Current Status of Care for Patients with CAD database. Glycemic control was evaluated using the time-weighted average glucose (TWAG) and the glucose coefficient of variation (CV) for each participant. The primary outcome was AKI occurrence.
A total of 2,454 CAD patients with prediabetes were included between January 2022 and June 2023. The mean age was 62.6 ± 10.3 years, with 27.1% female. In univariate analysis, each 1 mmol/L increase in TWAG was associated with a 1.51-fold (95% confidence interval (CI): 1.36-1.68) higher incidence of AKI. After stepwise adjustment for covariates, the odds ratio (OR) remained significant at 1.50 (95% CI: 1.35-1.67). Similarly, glucose CV showed a positive correlation with AKI risk; a 0.1-unit increase in CV was linked to approximately a 44% higher risk. When both TWAG and CV were included simultaneously in the model, each maintained an independent positive association with AKI. Restricted cubic spline analyses revealed a dose-dependent increase in AKI risk with rising TWAG and CV. Subgroup analyses confirmed the positive relationship between TWAG, glucose variability, and AKI risk.
Our study reveals an association between TWAG or CV of glucose and AKI in individuals with both CAD and prediabetes. These findings highlight the potential value of continuous glucose monitoring and managing glycemic variability to reduce AKI risk in this population.
验证强化血糖控制在预防冠心病（CAD）和糖尿病前期患者急性肾损伤（AKI）中的有效性。
本研究采用来自CAD患者当前护理状况前瞻性登记数据库的数据。使用每位参与者的时间加权平均血糖（TWAG）和血糖变异系数（CV）评估血糖控制情况。主要结局是AKI的发生。
2022年1月至2023年6月期间共纳入2454例患有糖尿病前期的CAD患者。平均年龄为62.6±10.3岁，女性占27.1%。在单因素分析中，TWAG每增加1 mmol/L，AKI的发生率就会高出1.51倍（95%置信区间（CI）：1.36 - 1.68）。在对协变量进行逐步调整后，比值比（OR）仍显著为1.50（95% CI：1.35 - 1.67）。同样，血糖CV与AKI风险呈正相关；CV每增加0.1个单位，风险就会增加约44%。当TWAG和CV同时纳入模型时，二者均与AKI保持独立的正相关关系。受限立方样条分析显示，随着TWAG和CV升高，AKI风险呈剂量依赖性增加。亚组分析证实了TWAG、血糖变异性与AKI风险之间的正相关关系。
我们的研究揭示了CAD合并糖尿病前期患者的血糖TWAG或CV与AKI之间的关联。这些发现凸显了持续血糖监测和管理血糖变异性对于降低该人群AKI风险的潜在价值。
