Can glycated hemoglobin act as a reliable glycemic indicator in patients with diabetic chronic kidney disease? evidence from the Northeast of Thailand

  • Sojib Bin Zaman Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka http://orcid.org/0000-0002-3043-7954
  • Naznin Hossain Department of Pharmacology, Dhaka Medical College, Dhaka
  • Ahmed E. Rahman Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka
  • Sheikh M.S. Islam Cardiovascular Division, George Institute for Global Health
Keywords: Diabetic CKD, eGFR, Glycated hemoglobin, Thailand
Abstract viewed: 1872 times
PDF downloaded: 478 times

Abstract

Background: Chronic kidney diseases (CKD) is a common microvascular complication in patients with diabetes mellitus (DM) which requires adequate glycemic control. Glycated hemoglobin (HbA1c) is a conventional biomarker to estimate glycemic status, but its role in diabetic CKD patients is unclear. Therefore, this study aimed to determine whether patients with high HbA1c are associated to develop diabetic CKD.

Methods: Data were obtained from a clinical registry of diabetic patients who were treated in a district hospital in the Northeast of Thailand. CKD was defined according to the estimated glomerular filtration rate (eGFR<60mL/min/1.73m2). Anthropometric and biochemical measurements of the patient were taken by review of medical records. Multiple logistic regression analysis was used to determine the likelihood of the association between HbA1c and CKD.

Results: Among 4,050 participants, 1,027 (25.3%) developed diabetic CKD. Older age (adjusted odds ratio (AOR): 4.88, 95% confidence interval (CI): 3.71–6.42, p<0.05), female (AOR: 1.38, 95% CI: 1.05–1.73, p<0.05), and hypertension (AOR: 1.52, 95% CI: 1.21–1.91, p<0.05) were found as the risk factors of diabetic CKD. However, patients with high HbA1c (>6.5%) were negatively associated with diabetic CKD (AOR: 0.66, 95% CI: 0.51–0.86, p<0.05).

Conclusion: This study found patients with higher HbA1c level were not associated with diabetic CKD. Therefore, using the conventional cut-off values of HbA1c in diabetic CKD patients may be problematic in the clinical settings. Enhanced detection of glycemic status in patients with diabetic CKD is warranted to improve the outcome.

References

  1. Chittinandana A. Thailand renal replacement therapy registry (TRT Registry) report. J Nephrol Soc Thailand. 2000;6:250–5.

  2. van Dieren S, Beulens JW, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil. 2010;17(suppl 1):S3–8. https://doi.org/10.1097/01.hjr.0000368191.86614.5a

  3. Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Fröschl G. Non‐communicable diseases (NCDs) in developing countries: a symposium report. Global Health. 2014;10(1):81. https://doi.org/10.1186/s12992-014-0081-9

  4. Jha V. End‐stage renal care in developing countries: the India experience. Ren Fail. 2004;26(3):201–8. https://doi.org/10.1081/JDI-120039516

  5. Zaman SB. Detection of Chronic Kidney Disease by Using Different Equations of Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Analysis. Cureus. 2017;9(6):e1352. https://doi.org/10.7759/cureus.1352

  6. Rossing K, Christensen PK, Hovind P, Tarnow L, Rossing P, Parving H-H. Progression of nephropathy in type 2 diabetic patients. Kidney Int. 2004;66(4):1596–605. https://doi.org/10.1111/j.1523-1755.2004.00925.x

  7. Bhutani J, Bhutani S. Worldwide burden of diabetes. Indian J Endocrinol Metab. 2014;18(6):868–70. https://doi.org/10.4103/2230-8210.141388

  8. Islam SM, Rawal LB, Mainuddin A, Wahiduzzaman M, Niessen LW. Clinical profile of patients with diabetic nephropathy in a tertiary level hospital in Dhaka, Bangladesh. Arch Med Health Sci. 2015;3(2):191. https://doi.org/10.4103/2321-4848.171902

  9. Nitiyanant W, Chetthakul T, Sang-A-kad P, Therakiatkumjorn C, Kunsuikmengrai K, Yeo JP. A survey study on diabetes management and complication status in primary care setting in Thailand. J Med Assoc of Thai. 2007;90(1):65–71.

  10. Koenig RJ, Peterson CM, Kilo C, Cerami A, Williamson JR. Hemoglobin AIc as an indicator of the degree of glucose intolerance in diabetes. Diabetes. 1976;25(3):230–2. https://doi.org/10.2337/diab.25.3.230

  11. Zaman SB, Hossain N. Universal Health Coverage: A burning need for developing countries. J Med Res & Innov. 2017;1(1):18–20.

  12. Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. Indicators for blood glucose control in diabetics with end-stage chronic renal disease: GHb vs. glycated albumin (GA). J Med Invest. 2006;53(3–4):223–8. https://doi.org/10.2152/jmi.53.223

  13. Freedman BI, Shenoy RN, Planer JA, Clay KD, Shihabi ZK, Burkart JM, et al. Comparison of glycated albumin and hemoglobin A1c concentrations in diabetic subjects on peritoneal and hemodialysis. Perit Dial Int. 2010;30(1):72–9. https://doi.org/10.3747/pdi.2008.00243

  14. Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007;18(3):896–903. https://doi.org/10.1681/ASN.2006070772

  15. Zaman SB, Hossain N, Ahammed S, Ahmed Z. Contexts and Opportunities of e-Health Technology in Medical Care. J Med Res & Innov. 2017;1(2):AV1–AV4.

  16. Muktabhant B, Sanchaisuriya P, Sarakarn P, Tawityanon W, Trakulwong M, Worawat S, et al. Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country. BMC Public Health. 2012;12:349. https://doi.org/10.1186/1471-2458-12-349

  17. www.who.int [Internet]. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. [update 2011; cited May 2017]. Available form: http://www.who.int/cardiovascular_diseases/report-hba1c_2011_edited.pdf

  18. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Inter Med. 2003;139(2):137–47. https://doi.org/10.7326/0003-4819-139-2-200307150-00013

  19. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Inter Med. 2009;150(9):604–12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

  20. Vos FE, Schollum JB, Coulter CV, Manning PJ, Duffull SB, Walker RJ. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrology (Carlton). 2012;17(2):182–8. https://doi.org/10.1111/j.1440-1797.2011.01517.x

  21. Agarwal R, Light RP. Relationship between glycosylated hemoglobin and blood glucose during progression of chronic kidney disease. Am J Nephrol. 2011;34(1):32–41. https://doi.org/10.1159/000328737

  22. Ly J, Marticorena R, Donnelly S. Red blood cell survival in chronic renal failure. Am J Kidney Dis. 2004;44(4):715–9. https://doi.org/10.1016/S0272-6386(04)00951-5

  23. Zaman SB. Importance of Learning the Public Health Leadership. Public Health Indones. 2017;3(1):1–3.

  24. Srivanichakorn S, Sukpordee N, Yana T, Sachchaisuriya P, Schelp FP. Health status of diabetes type 2 patients in Thailand contradicts their perception and admitted compliance. Prim Care Diabetes. 2011;5(3):195–201. https://doi.org/10.1016/j.pcd.2011.02.005

  25. Islam S, Rawal L. Setting HbA1c targets for patients with type 2 diabetes. J Diabetol. 2015;2:5.

Published
2017-08-18
How to Cite
1.
Zaman SB, Hossain N, Rahman AE, Islam SM. Can glycated hemoglobin act as a reliable glycemic indicator in patients with diabetic chronic kidney disease? evidence from the Northeast of Thailand. Med J Indones [Internet]. 2017Aug.18 [cited 2019Nov.19];26(2):102-8. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1995
Section
Clinical Research