Association between Hemoglobin A1c and Renal Arteriolar Sclerosis in Subjects Presenting without any Apparent Kidney
Yuta Matsukuma1, Akihiro Tsuchimoto1, Kosuke Masutani1,2
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.
Insights
Elevated hemoglobin A1c (HbA1c) levels, even in the prediabetic range, are linked to increased renal arteriolar wall thickening. This suggests subclinical kidney damage may occur before a diabetes mellitus diagnosis.
Area of Science:
- Nephrology
- Endocrinology
- Vascular Biology
Background:
- Diabetic kidney disease is a significant complication of diabetes mellitus (DM).
- The relationship between hemoglobin A1c (HbA1c) levels, particularly prediabetic ranges, and renal pathological changes is not fully understood.
- Investigating early renal changes in individuals without overt kidney dysfunction is crucial.
Purpose of the Study:
- To examine the association between HbA1c levels and renal arteriolar lesions in living kidney donors without apparent kidney dysfunction.
- To determine if prediabetic HbA1c levels are associated with subclinical renal arteriolar sclerosis.
Main Methods:
- A cohort of 393 living kidney donors underwent baseline kidney biopsy between 2006 and 2016.
- Donors were categorized into four groups based on HbA1c levels: <5.6%, 5.6%-5.7%, 5.8%-6.4%, and ≥6.5% (DM group).
- Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading.
Main Results:
- Arteriolar hyalinization was present in 40.2% and wall thickening in 37.6% of donors.
- A significant correlation was found between HbA1c levels and arteriolar wall thickening (p<0.001).
- Elevated HbA1c levels (5.6%-5.7% and 5.8%-6.4%) were independently associated with increased arteriolar wall thickening compared to levels <5.6%.
Conclusions:
- High-normal HbA1c levels are independent risk factors for renal arteriolar wall thickening.
- Subclinical renal arteriolar sclerosis may develop in individuals with prediabetic HbA1c levels.
- Early detection and management of elevated HbA1c may help prevent kidney damage.
Aims:
Diabetic kidney disease is a major vascular complication in patients with diabetes mellitus (DM). However, the association between the hemoglobin (Hb)A1c levels, notably the prediabetic levels, and renal pathological changes remains unclear. We investigated the association between the HbA1c levels and renal arteriolar lesions in subjects without any apparent kidney dysfunction using a living kidney donor cohort.
Methods:
Between January 2006 and May 2016, 393 living kidney donors underwent a "zero-time" biopsy at Kyushu University Hospital. The patients were divided into four groups (HbA1c levels ＜5.6%, 5.6%-5.7%, 5.8%-6.4%, and ≥ 6.5%, or diagnosed with DM [DM group]). Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading. We then investigated the association between the HbA1c levels and renal pathological changes.
Results:
158 (40.2%) patients had arteriolar hyalinization and 148 (37.6%) showed wall thickening. A significant correlation was observed between the HbA1c levels and wall thickening (p for trend ＜0.001). An elevated HbA1c level was significantly associated with wall thickening according to a multivariable logistic analysis in subjects with HbA1c levels of 5.6%-5.7% and 5.8%-6.4%, and the DM group, compared with those with HbA1c levels of ＜5.6% (odds ratio [OR], 1.91; 95% confidence interval [CI]: [1.03-3.54] for 5.6%-5.7%, OR, 1.96; 95% CI: [1.09-3.53] for 5.8%-6.4%, and OR, 2.86; 95% CI: [0.91-9.01] for the DM group), whereas arteriolar hyalinization did not increase within the nondiabetic HbA1c levels.
Conclusions:
Elevated high-normal HbA1c levels are considered to be independent risk factors for arteriolar wall thickening. Subclinical renal arteriolar sclerosis may develop in patients with prediabetic HbA1c levels.
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