title: Diabetes Control and the Risks of ESRD and Mortality in Patients With CKD.
abstract: BACKGROUND
  Diabetes is the leading cause of end-stage renal disease (ESRD) and a significant contributor to mortality in the general population. We examined the associations of hemoglobin A1c(HbA1c) levels with ESRD and death in a population with diabetes and chronic kidney disease (CKD).
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  6,165 patients with diabetes (treated with oral hypoglycemic agents and/or insulin) and CKD stages 1 to 5 at a large health care system.
  
  
  METHODS
  HbA1clevel (examined as a categorical and continuous measure).
  
  
  RESULTS
  All-cause and cause-specific mortality ascertained from the Ohio Department of Health mortality files and ESRD ascertained from the US Renal Data System.
  
  
  RESULTS
  During a median 2.3 years of follow-up, 957 patients died (887 pre-ESRD deaths) and 205 patients reached ESRD. In a Cox proportional hazards model, after multivariable adjustment including for kidney function, HbA1clevel < 6% was associated with higher risk for death when compared with HbA1clevels of 6% to 6.9% (HR, 1.23; 95% CI, 1.01-1.50). Similarly, HbA1clevel ≥ 9% was associated with higher risk for all-cause death (HR, 1.34; 95% CI, 1.06-1.69). In competing-risk models, baseline HbA1clevel was not associated with ESRD. For cause-specific mortality, diabetes accounted for >12% of deaths overall and >19% of deaths among those with HbA1clevels > 9%.
  
  
  CONCLUSIONS
  Small proportion of participants with advanced kidney disease; single-center population.
  
  
  CONCLUSIONS
  In this cohort of patients with CKD with diabetes, HbA1clevels < 6% and ≥9% were associated with higher risk for death. HbA1clevels were not associated with ESRD in this specific CKD population. Diabetes-related deaths increased with higher HbA1clevels.
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address: sankar.navaneethan@bcm.edu.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Medicine Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Stacey E
authors.initials: SE
authors.lastname: Jolly
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D018570:Risk Assessment
chemical_list: D006442:Glycated Hemoglobin
keywords: Glycated hemoglobin; HbA(1c); chronic kidney disease (CKD); death and kidney disease; diabetes control; diabetes mellitus; diabetic nephropathy; end stage renal disease (ESRD); incident ESRD; mortality