Association Between Glycosylated Hemoglobin Level and 16-Year Incidence of Chronic Kidney Disease in Type 1 Diabetes

Abstract

Context: The incidence of recently defined outcome of chronic kidney disease (CKD) has not been widely reported in type 1 diabetes. Objective: To examine the prospective association between baseline glycosylated hemoglobin levels and the 16-year incidence of CKD and end-stage renal disease (ESRD) in type 1 diabetes. Design: Prospective cohort study of type 1 diabetes individuals. Setting: Community based in southwestern Wisconsin. Participants: 547 younger-onset type 1 diabetes individuals who were free of CKD at baseline (1984-86). Main Outcome Measures: Development of CKD (defined as estimated glomerular filtration rate2 or ESRD [history of dialysis or renal transplantation]) over 16-year follow-up period, among individuals free of CKD at baseline. Alternate outcome was 16-year incident ESRD. Results: After 16 years of follow-up, there were 158 cases of CKD and 37 cases of ESRD in our cohort. The 16-year cumulative incidence of CKD was 31.7 percent. Elevated glycosylated hemoglobin levels were associated with incident CKD and ESRD in separate models. Multivariable odds ratio (OR) [95% confidence intervals (CI)] comparing the highest quartile of glycosylated hemoglobin (11-15.3%) to the lowest quartile (6-8.6%) was 6.44 (3.61-11.51), p-trendConclusions: Higher baseline glycosylated hemoglobin levels are independently associated with incident CKD and ESRD, among individuals with type 1 diabetes.