Risk of chronic kidney disease defined by decreased estimated glomerular filtration rate in individuals with different prediabetic phenotypes: results from a prospective cohort study in China

Abstract

ObjectiveWe aimed to investigate the effects of prediabetes and its phenotypes of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycated hemoglobin A1c (EHbA1c) on chronic kidney disease (CKD) occurrence, and define the cut-off point of each glycemic index that significantly increases the risk of CKD.Research design and methodsIn this prospective cohort study, 6446 non-diabetic subjects aged 40 years and over were followed over a period of 3 years to track the new onset of CKD. Cox regression was used to assess the association of prediabetes and its phenotypes with CKD. Receiver operating characteristic curves were used to define the cut-off point of each glycemic index that significantly increases the occurrence of CKD. Population attributable risk percent was calculated to estimate the contribution of prediabetes to CKD.ResultsCompared to subjects with normal glucose tolerance, patients with prediabetes significantly increased the risk of development of CKD (HR=2.33 (1.19–4.55)). Specifically, this increased risk of CKD development was observed in patients with IFG, IGT and EHbA1c. The cut-off points shown to significantly increase the risk of CKD are fasting plasma glucose of 5.63 mmol/L, 2-hour plasma glucose of 6.80 mmol/L and HbA1c of 5.6%. The contribution of prediabetes to CKD occurrence in the study population was 60.6%.ConclusionsThis result suggests that the stricter criteria might be needed to define normal plasma glucose level in China that would not be predisposed to diabetic complications, particularly CKD.

Chronic Microvascular Complications in Prediabetic States—An Overview

“…For some years, evidence for a correlation between an increased risk of chronic kidney disease (CKD) and diabetic kidney disease (DKD) in prediabetes has been recorded [ 35 , 46 ]. Characteristic features found in 14 cohort studies are summarized in Table 2 [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Half of the studies [ 48 , 49 , 50 , 51 , 52 , 53 , 54 ] were designed mainly to assess the relationship between metabolic syndrome and CKD.…”

“…The size of groups in the presented cohorts ranged from 2398 to 118,924. The European population [ 55 , 56 , 58 ] and the American population [ 47 , 48 , 50 ] were each assessed in three studies, while eight studies concerned the Asian population [ 49 , 51 , 52 , 53 , 54 , 57 , 59 , 60 ]. Some of the European and American studies included multi-ethnic populations, but the white population constituted at least 50% in each of them.…”

“…Five studies additionally included microalbuminuria or proteinuria in the definition of CKD [ 49 , 50 , 53 , 57 , 58 ]. The degree to which the co-variables were adapted differed in particular studies; only six studies included the baseline eGFR [ 47 , 52 , 55 , 57 , 59 , 60 ]. Only in four out of fourteen studies did IFG not increase the probability of CKD [ 53 , 55 , 59 ]; in the remaining studies, it was at least slightly increased.…”

“…Only in four out of fourteen studies did IFG not increase the probability of CKD [ 53 , 55 , 59 ]; in the remaining studies, it was at least slightly increased. The latest research shows that prediabetes, defined through IGT or HbA1c [ 57 , 59 , 60 ], is a strong independent predicator for CKD.…”

Machine Learning Approaches Reveal Metabolic Signatures of Incident Chronic Kidney Disease in Individuals With Prediabetes and Type 2 Diabetes

“…Among the established risk factors for CKD, diabetes mellitus accounts for 30%-50% of all CKD cases (2) and its microvascular complication, diabetic nephropathy, is the leading cause of end-stage kidney disease (3). Moreover, undiagnosed diabetes and pre-diabetes have been related with high prevalence of CKD in US, European and Asian populations (4)(5)(6)(7). Early screening of hyperglycemic individuals under risk of developing CKD is therefore crucial for effective prevention and management of incident CKD in the framework of an integrated personalized diabetes management (8).…”