Over the past 20 years, the prevalence
of albuminuria has decreased while kidney function decline has increased. Still,
rates of diabetic kidney disease have remained the same. In a poster
presentation at the live virtual National Kidney
Foundation 2020 Spring Clinical Meetings, investigators report that better
glycemic control correlates with less albuminuria but not improved estimated
glomerular filtration rate (eGFR).
Kamyar Kalantar-Zadeh, MD,
MPH, PhD, of the University of California
Irvine, and collaborators stratified 5647 self-reported diabetes patients from
the National Health and Nutrition Examination Survey (1999-2016) by their level
of glycemic control – good (A1c less than 7%), intermediate (A1c 7%-9%), and,
poor (A1c 9% or more) – and by their clinical manifestation of kidney disease.
More patients with good
glycemic control displayed only an eGFR less than 60 mL/min/1.73 m2, whereas more patients with poor glycemic control displayed only a
urinary albumin-to-creatinine ratio (UACR) less than 30 mg/g. In adjusted multivariable
linear regression models excluding hyperfiltration cases, A1c only significantly
correlated with albuminuria.
“This study demonstrated
that better glycemic control is associated with decreased albuminuria among patients
with diabetes, but not with improved eGFR level,” lead author Mitra Mosslemi,
MSc, told Renal & Urology News. “Our
results highlight the importance of following diabetes screening
recommendations to track eGFR along with albuminuria routinely, even in
patients with optimal glycemic control.”
The team is currently working on another
study characterizing the differences between normoalbuminuric and albuminuric
CKD in patients with diabetes. The preliminary results are scheduled to be
released at the American Diabetes Association Scientifics Sections in June
2020. They also plan to investigate alternative diagnostic markers for
detecting diabetic kidney disease in the absence of albuminuria.
Read more of our coverage of the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings by visiting the conference page.
Reference
Mosslemi M, Wenziger C, Hsiung J-T, Kalantar-Zadeh K, Rhee C, Hanna R, Streja E. Association of glycemic control level with the clinical manifestation of kidney injury among patients with diagnosed diabetes. Data presented at the live virtual National Kidney Foundation 2020 Spring Clinical Meetings held March 25 to 29. ePoster 311.
