Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality

Çöpür, Sidar; Önal, Emine Meltem; Afsar, Barış; Ortíz, Alberto; Raalte, Daniël H. van; Cherney, David Z.I.; Rossing, Peter; Kanbay, Mehmet

doi:10.1016/j.jdiacomp.2020.107707

Cited by 32 publications

(20 citation statements)

References 207 publications

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“…Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease worldwide and has detrimental consequences for cardiovascular health and mortality. [1][2][3] Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease, regardless of cause. Diabetes mellitus (DM) is also frequently an unwanted consequence of solid organ transplantation (SOT), due to a variety of nonmodifiable and modifiable risk factors.…”

Section: Introductionmentioning

confidence: 99%

Sodium‐glucose cotransporter 2 inhibitors for diabetes mellitus control after kidney transplantation: Review of the current evidence

et al. 2021

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Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are promising drugs to treat chronic kidney disease patients with or without diabetes mellitus (DM). Besides improving glycemic control, SGLT2i are cardioprotective and kidney protective and decrease bodyweight, serum uric acid, blood pressure, albuminuria and glomerular hyperfiltration. These effects may benefit graft function and survival in kidney transplant (KT) patients. In this review, we evaluate data on the efficacy and safety of SGLT2i for KT patients with DM. Eleven studies with 214 diabetic KT patients treated with SGLT2i have been reported. SGLT2i lowered haemoglobin A1c and bodyweight. While glomerular filtration rate may be reduced in the short-term, it remained similar to baseline after 3-12 months. In two studies, blood pressure decreased and remained unchanged in the others. There were no significant changes in urine protein to creatinine ratio. Regarding safety, 23 patients had urinary tract infections, 2 patients had a genital yeast infection, one had acute kidney injury, and one had mild hypoglycaemia. No cases of ketoacidosis or acute rejection were reported. In conclusion, the limited experience so far suggests that SGLT2i are safe in KT patients with DM, decrease bodyweight and improve glycemic control. However, some of the benefits observed in larger studies in the non-KT population have yet to be demonstrated in KT recipients, including preservation of kidney function, reduction in blood pressure and decreased proteinuria.

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Section: Introductionmentioning

confidence: 99%

Sodium‐glucose cotransporter 2 inhibitors for diabetes mellitus control after kidney transplantation: Review of the current evidence

et al. 2021

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“…In Colombia, both types of insurance have similar access to healthcare services and medications [ 34 ], complicating comparisons with other health systems. A possible explanation to our findings could be a higher proportion of stage 5 CKD in the state insurance compared with third payer affiliates (10% versus 1.81%) since the precision of HbA1c reduces with advanced CKD stages and this can lead to underestimation of glycemic levels [ 31 , 35 ]. Furthermore, when evaluating the interaction between CKD and ethnicity, we found that afro descendants living with DM and CKD also had an increased probability of PGC compared to those without CKD.…”

Section: Discussionmentioning

confidence: 99%

The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data

Urina-Jassir¹,

Herrera-Parra²,

Vargas³

et al. 2021

BMC Endocr Disord

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Background Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. Methods A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. Results From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. Conclusions Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.

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“…45 It reflects glycaemic status of the preceding 2-3 weeks, based on albumins short half-life, and shows a strong correlation with complications of DKD. 46 As the level is independent of the Hb amount, the RBCs lifespan, iron, and EPO treatment, GA is thought to have some advantages over HbA1c in DKD. 47 Most studies have reported that GA is better than HbA1c in reflecting glycaemia in DKD; especially in stage 4 and 5, including those on dialysis.…”

Section: Haemolysismentioning

confidence: 99%

“…Conversely, hypoosmolality and hyperphosphatemia, which are also common in DKD, may accelerate albumin glycation; thus, increasing the GA level; regardless of glycaemia. 46 Though demonstrating superior accuracy in reflecting glycaemia, as compared to HbA1c in DKD in some studies, its performance data at different stages of kidney disease in comparison to HbA1c is still insufficient. In addition to that, non-standardized measurement methods and lack of uniform reference ranges also restrict the wider use of this biomarker.…”

Section: Haemolysismentioning

confidence: 99%

“…As with GA, the lack of any standardized method measurement has also further contributed to the limited use of serum fructosamine in patients with DKD. 46 The value of CGM in DKD CGM utilizes sensors implanted in the subcutaneous tissue to measure the interstitial glucose concentration at pre-determined time intervals within a specific duration. The accuracy of the device has been proven satisfactory when compared with the serum glucose levels.…”

Section: Haemolysismentioning

confidence: 99%

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Glycaemic Monitoring in Diabetic Kidney Disease – Is HbA1c Reliable?

Isa

Hami

et al. 2021

J Health Sci Med Res

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Diabetic kidney disease (DKD) is a known complication of diabetes mellitus that increases patients’ risks of developing end-stage renal failure requiring dialysis treatment and vulnerability of fatal outcomes resulted from cardiovascular events. Therefore, a good diabetic control among patients with DKD is essential. Nevertheless, monitoring glycaemia in DKD is very challenging. The use of the gold standard glycaemic marker, haemoglobin A1c (HbA1c), is complicated by many hindrances associated with both biochemical and physiological derangements of DKD. Despite the constraints, the Kidney Disease Improving Global Outcome has recommended the use of HbA1c as a reliable glycaemic marker in DKD patients, whose estimated glomerular filtration rate is down to 30 millilitres/minute per 1.73 meter2 . In this article, we discuss the reliability and limitations of HbA1c as an advocated glycaemic marker in DKD. Considering that the reliability of HbA1c is highly dependent on the interpretation of the results, we also highlighted the common potential factors that can affect HbA1c interpretation in patients with DKD. The article also discusses the issues related to the utility of glycated albumin and serum fructosamine as alternative glycaemic biomarkers, and continuous glucose monitoring as a complementary marker to HbA1c in clinical practice. Understanding the HbA1c values and their limitations is important to ensure accurate interpretation of glycaemic status and to achieve optimal diabetic control in patients with DKD.

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Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality

Cited by 32 publications

References 207 publications

Sodium‐glucose cotransporter 2 inhibitors for diabetes mellitus control after kidney transplantation: Review of the current evidence

Sodium‐glucose cotransporter 2 inhibitors for diabetes mellitus control after kidney transplantation: Review of the current evidence

The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data

Glycaemic Monitoring in Diabetic Kidney Disease – Is HbA1c Reliable?

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