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Glycemic control predicts diabetic extrarenal microvascular complications but not renal survival in patients with moderate to severe chronic kidney disease.
Ethn Dis. 2006 Autumn; 16(4):865-71.ED

Abstract

BACKGROUND

Control of blood pressure (BP) and blood glucose can slow the development of diabetic nephropathy (DN). However, BP control may be of relatively more importance than glycemic control on the progression of DN.

OBJECTIVE

To determine the effects of glycemic control on renal survival in a predominantly African American diabetic population with moderate-to-severe renal disease.

DESIGN

This was a retrospective chart review of all diabetic patients seen in an academic nephrology clinic in 2001 and 2002 for renal survival and its predictors and micro/macrovascular disease. The weighted mean glycosylated hemoglobin (GHb) over followup was determined. Mean GHb < or = 9 was defined as low, and GHb >9 was high. The effect of glycemic control on endpoints was determined by Cox proportional hazards and logistic regression.

RESULTS

One hundred fifty-five diabetic patients (87.7% African American, mean creatinine =2.2 mg/dL) had sufficient GHb measurements. Compared to the high group (n=81), the low group (n=74) was significantly younger, had a shorter duration of diabetes, and worse renal function. No significant association of glycemic control with renal survival (ESRD) was seen. Glycemic control and the presence of DN were significantly related to extrarenal microvascular complications, independent of other factors.

CONCLUSION

Glycosylated hemoglobin (GHb) is not a significant predictor of renal survival in patients with diabetes and moderate renal disease. However, glycemic control does predict extrarenal microvascular complications in this population. Therefore, good metabolic control remains important in patients with diabetes and renal disease.

Authors+Show Affiliations

Crook ED
Division of Nephrology, Department of Medicine, Wayne State University School of Medicine and John D. Dingell VAMC, Detroit, Michigan, USA. ecrook@usouthal.edu
Patel S
No affiliation info available

MeSH

African AmericansBiomarkersBlood GlucoseBlood PressureCreatinineDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic NephropathiesDiabetic RetinopathyDisease ProgressionFemaleFollow-Up StudiesGlomerular Filtration RateGlycated Hemoglobin AHumansKidney Failure, ChronicLogistic ModelsMaleMedical RecordsMichiganMicrocirculationMiddle AgedMultivariate AnalysisPredictive Value of TestsProportional Hazards ModelsResearch DesignRetrospective StudiesSeverity of Illness IndexSurvival Rate

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17061739

Citation

Crook, Errol D., and Sejal Patel. "Glycemic Control Predicts Diabetic Extrarenal Microvascular Complications but Not Renal Survival in Patients With Moderate to Severe Chronic Kidney Disease." Ethnicity & Disease, vol. 16, no. 4, 2006, pp. 865-71.
Crook ED, Patel S. Glycemic control predicts diabetic extrarenal microvascular complications but not renal survival in patients with moderate to severe chronic kidney disease. Ethn Dis. 2006;16(4):865-71.
Crook, E. D., & Patel, S. (2006). Glycemic control predicts diabetic extrarenal microvascular complications but not renal survival in patients with moderate to severe chronic kidney disease. Ethnicity & Disease, 16(4), 865-71.
Crook ED, Patel S. Glycemic Control Predicts Diabetic Extrarenal Microvascular Complications but Not Renal Survival in Patients With Moderate to Severe Chronic Kidney Disease. Ethn Dis. 2006;16(4):865-71. PubMed PMID: 17061739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glycemic control predicts diabetic extrarenal microvascular complications but not renal survival in patients with moderate to severe chronic kidney disease. AU - Crook,Errol D, AU - Patel,Sejal, PY - 2006/10/26/pubmed PY - 2007/7/12/medline PY - 2006/10/26/entrez SP - 865 EP - 71 JF - Ethnicity & disease JO - Ethn Dis VL - 16 IS - 4 N2 - BACKGROUND: Control of blood pressure (BP) and blood glucose can slow the development of diabetic nephropathy (DN). However, BP control may be of relatively more importance than glycemic control on the progression of DN. OBJECTIVE: To determine the effects of glycemic control on renal survival in a predominantly African American diabetic population with moderate-to-severe renal disease. DESIGN: This was a retrospective chart review of all diabetic patients seen in an academic nephrology clinic in 2001 and 2002 for renal survival and its predictors and micro/macrovascular disease. The weighted mean glycosylated hemoglobin (GHb) over followup was determined. Mean GHb < or = 9 was defined as low, and GHb >9 was high. The effect of glycemic control on endpoints was determined by Cox proportional hazards and logistic regression. RESULTS: One hundred fifty-five diabetic patients (87.7% African American, mean creatinine =2.2 mg/dL) had sufficient GHb measurements. Compared to the high group (n=81), the low group (n=74) was significantly younger, had a shorter duration of diabetes, and worse renal function. No significant association of glycemic control with renal survival (ESRD) was seen. Glycemic control and the presence of DN were significantly related to extrarenal microvascular complications, independent of other factors. CONCLUSION: Glycosylated hemoglobin (GHb) is not a significant predictor of renal survival in patients with diabetes and moderate renal disease. However, glycemic control does predict extrarenal microvascular complications in this population. Therefore, good metabolic control remains important in patients with diabetes and renal disease. SN - 1049-510X UR - https://www.unboundmedicine.com/medline/citation/17061739/Glycemic_control_predicts_diabetic_extrarenal_microvascular_complications_but_not_renal_survival_in_patients_with_moderate_to_severe_chronic_kidney_disease_ L2 - http://www.diseaseinfosearch.org/result/3996 DB - PRIME DP - Unbound Medicine ER -