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Predictive Value of HbA1c and Metabolic Syndrome for Renal Outcome in Non-Diabetic CKD Stage 1-4 Patients

Chi-Chih Hung1, Yen-Yi Zhen1, Sheng-Wen Niu1,2

  • 1Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.

Biomedicines
|August 26, 2022
PubMed

Insights

Glycated hemoglobin (HbA1c) impacts kidney health differently in patients with metabolic syndrome (MetS). Higher HbA1c worsens kidney outcomes in MetS patients but improves them in non-MetS patients with chronic kidney disease (CKD).

Area of Science:

  • Nephrology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Glycated hemoglobin (HbA1c) indicates glycemic control and is linked to pre-diabetes and metabolic syndrome (MetS).
  • Chronic kidney disease (CKD) can affect HbA1c levels, complicating its interpretation.
  • The relationship between HbA1c and clinical outcomes in nondiabetic CKD patients with or without MetS is not well understood.

Purpose of the Study:

  • To investigate the association between HbA1c levels and clinical outcomes in nondiabetic patients with stages 1-4 CKD.
  • To determine if metabolic syndrome modifies the relationship between HbA1c and renal outcomes or all-cause mortality.

Main Methods:

  • Linear regression analyzed factors associated with HbA1c in 1270 nondiabetic Asian CKD patients.
  • Cox regression assessed the association between HbA1c levels (categorized) and composite renal outcomes and all-cause mortality.
  • Patients were stratified based on the presence or absence of metabolic syndrome.

Main Results:

  • HbA1c levels were higher in patients with MetS (5.7%) compared to those without (5.5%).
  • Higher HbA1c was linked to worse composite renal outcomes in MetS patients (HR 2.00) but better outcomes in non-MetS patients (HR 0.25).
  • No significant association was found between HbA1c and all-cause mortality.

Conclusions:

  • HbA1c's association with renal outcomes in nondiabetic CKD patients is significantly modified by the presence of metabolic syndrome.
  • Higher HbA1c predicts worse renal outcomes in CKD patients with MetS.
  • Lower HbA1c may indicate better renal outcomes in CKD patients without MetS.

Keywords:
HbA1cchronic kidney diseasemetabolic syndrome

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