scholarly journals Glycemic control and the risk of acute kidney injury in patients with type 2 diabetes and chronic kidney disease: parallel population-based cohort studies in U.S. and Swedish routine care

2020 ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Marie Evans ◽  
Jung-Im Shin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Glycemic Control ◽  
Kidney Injury ◽  
Routine Care ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Swedish Cohort ◽  
The U.S

<b>Objective: </b>Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but mechanisms are unclear. We investigated the association of glycemic control with risk of AKI. <p><b>Research Design and Methods: </b>In two observational cohorts of U.S. (Geisinger Heath system, Pennsylvania) and Swedish (SCREAM project, Stockholm) adults with type-2 diabetes and confirmed CKD stages G3-G5 undergoing routine care, we evaluated associations between baseline and time-varying HbA1c with the incident AKI (defined as increase in creatinine ≥0.3 mg/dL over 48 hours, 1.5x creatinine over 7 days). </p> <p><b>Results: </b>In the U.S. cohort, there were 22877 patients (55% women) with median age 72 years and eGFR 52 ml/min/1.73 m<sup>2</sup>. In the Swedish cohort, there were 12157 patients (51% women) with median age 76 years and eGFR 51 ml/min/1.73 m<sup>2</sup>. During 3.1 and 2.3 years of follow-up, 7060 and 2619 AKI events were recorded in the U.S. and Swedish cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts. Compared to baseline HbA1c 6-6.9% (42-52 mmol/mol), the HR for AKI in patients with HbA1c>9% (75 mmol/mol) was 1.29 (95% CI 1.18-1.41) in Geisinger, and 1.33 (95% CI 1.13-1.57) in the Swedish cohort. Results were consistent in stratified analysis, when using death as competing risk, and when using time-varying HbA1c.</p> <p><b>Conclusions: </b>Higher HbA1c was associated with AKI in adults with type 2 diabetes and CKD, suggesting that improving glycemic control may reduce the risk of AKI.</p>

scholarly journals Glycemic control and the risk of acute kidney injury in patients with type 2 diabetes and chronic kidney disease: parallel population-based cohort studies in U.S. and Swedish routine care

2020 ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Marie Evans ◽  
Jung-Im Shin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Glycemic Control ◽  
Kidney Injury ◽  
Routine Care ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Swedish Cohort ◽  
The U.S

<b>Objective: </b>Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but mechanisms are unclear. We investigated the association of glycemic control with risk of AKI. <p><b>Research Design and Methods: </b>In two observational cohorts of U.S. (Geisinger Heath system, Pennsylvania) and Swedish (SCREAM project, Stockholm) adults with type-2 diabetes and confirmed CKD stages G3-G5 undergoing routine care, we evaluated associations between baseline and time-varying HbA1c with the incident AKI (defined as increase in creatinine ≥0.3 mg/dL over 48 hours, 1.5x creatinine over 7 days). </p> <p><b>Results: </b>In the U.S. cohort, there were 22877 patients (55% women) with median age 72 years and eGFR 52 ml/min/1.73 m<sup>2</sup>. In the Swedish cohort, there were 12157 patients (51% women) with median age 76 years and eGFR 51 ml/min/1.73 m<sup>2</sup>. During 3.1 and 2.3 years of follow-up, 7060 and 2619 AKI events were recorded in the U.S. and Swedish cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts. Compared to baseline HbA1c 6-6.9% (42-52 mmol/mol), the HR for AKI in patients with HbA1c>9% (75 mmol/mol) was 1.29 (95% CI 1.18-1.41) in Geisinger, and 1.33 (95% CI 1.13-1.57) in the Swedish cohort. Results were consistent in stratified analysis, when using death as competing risk, and when using time-varying HbA1c.</p> <p><b>Conclusions: </b>Higher HbA1c was associated with AKI in adults with type 2 diabetes and CKD, suggesting that improving glycemic control may reduce the risk of AKI.</p>

MO050GLYCEMIC CONTROL AND THE RISK OF AKI IN PATIENTS WITH DIABETES AND CKD: PARALLEL POPULATION-BASED COHORT STUDIES IN U.S. AND SWEDEN ROUTINE CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Alexander Chang ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Cohort Studies ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Patients With Diabetes ◽  
Swedish Cohort ◽  
The U.S

Abstract Background and Aims Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but the underlying mechanisms are not well known. We here explore the association between glycemic control and risk of AKI. Method We created two parallel observational cohort studies of Swedish (SCREAM project, Stockholm, 2006-2011) and U.S. (Geisinger Heath system, Pennsylvania, 1996-2018) adult patients with diabetes mellitus and confirmed CKD stages G3-G5. Glycemic control was evaluated through repeated HbA1c measurements, which were categorized into 5 levels of glycemic control intensity, with HbA1c 6-6.9% as referent category, and continuously using cubic splines. We evaluated the association between baseline and time-varying HbA1c levels with AKI (defined as increase in creatinine &gt;=0.3 mg/d over 48 hours or 1.5x creatinine over 7 days) using Cox proportional hazards regression and, in sensitivity analyses, Fine and Gray competing risk models accounting for death. Results In the Swedish cohort, there were 13932 patients with median age 76 years, 51% women, median eGFR 50.8 (Interquartile Range (IQR) 41.4-57.1) ml/min/1.73. In the U.S. cohort, there were 26520 patients with median age 71 years, 55% women and 52.1 (IQR 43.4-57.5) ml/min/1.73 m2. During a median of 2.3 and 3.1 years of follow up, 3172 and 8671 AKI events were recorded in the Swedish and US cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts, with the lowest risk between 6-6.9% and higher risk at higher levels of HbA1c. Compared to baseline HbA1c 6-6.9%, baseline HbA1c&gt;9% associated with a 1.28 fold (95% CI 1.11-1.47) higher risk of AKI in the Swedish cohort, and a 1.14 (95% CI 1.04-1.25) higher risk in the U.S. cohort. Conversely, baseline HbA1c&lt;6% did not associate with AKI. When using time-varying HbA1c, AKI risk was higher for HbA1c&gt;9% (HR 1.18, 95% CI 1.03-1.37 in Swedish cohort and 1.27, 1.17-1.37 in U.S. cohort); AKI risk was also higher for HbA1c&lt;6% in the U.S. cohort (1.12, 1.04-1.19), but not in the Swedish cohort (1.06, 0.97-1.16)). Conclusion Higher A1c was associated with AKI in adults with diabetes and CKD, suggesting that better glycemic control may also reduce risk of AKI.

FC 070USE OF POTENTIALLY NEPHROTOXIC MEDICATIONS IN PERSONS WITH CHRONIC KIDNEY DISEASE: PARALLEL COHORT STUDIES IN SWEDISH AND U.S ROUTINE CARE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alessandro Bosi ◽  
Juan Jesus Carrero ◽  
Jung-Im Shin ◽  
Yunwen Xu ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Drug Events ◽  
Medication Use ◽  
Kidney Injury ◽  
Routine Care ◽  
Clinical Predictors ◽  
Nephrotoxic Drugs ◽  
Study Inclusion ◽  
Swedish Cohort

Abstract Background and Aims Many adverse drug events are preventable, such as those potentially resulting from the prescription of nephrotoxic drugs to persons with chronic kidney disease (CKD). We here quantify the extent of contemporary nephrotoxic medication use in patients with CKD. Method In two observational cohorts of Swedish (Stockholm CREAtinine Measurements [SCREAM] project, Stockholm, Sweden) and U.S. (Geisinger Health System, Pennsylvania) adults with confirmed CKD stages G3-G5 undergoing routine care during 2016-2018, we explored the prescription (in U.S.) and dispensation (in Sweden) of 115 different ambulatory drugs with proven or purported nephrotoxicity during the 12 months following study inclusion. We evaluated the proportion of participants receiving nephrotoxic drugs, ranked main contributors and identified clinical predictors. Results In the Swedish cohort, there were 57880 patients (54.6% women) with median age of 80.00 (inter-quartile range [IQR]: 73.0-86.0) years and eGFR 48.9 ([IQR]: 39.9-55.0) mL/min/1.73 m2. In the U.S. cohort, there were 16255 patients (59% women) with median age of 76 years and eGFR 44 mL/min/1.73 m2. During observation, 20% (Sweden) and 17% (U.S.) of patients received at least one nephrotoxic drug. The top 3 potentially inappropriate nephrotoxic drugs identified were NSAIDs (9% and 11% of participants in U.S. and Sweden received it), antivirals (2.0% and 2.5%) and immunosuppressants (1.5% and 2.7%). Bisphosphonate use was common in Sweden (3.3% of participants), but not in U.S. (0.5%). Conversely, fenofibrates were common in U.S. (3.6%), but not in Sweden (0.13%). In adjusted analyses, patients with young age (&lt;65 years old), women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts (P&gt;0.05 for all). Notably, patients aware of their CKD (identified either by issued diagnosis or recent visit to a nephrologist), were at lower risk of nephrotoxic drug use (OR 0.87, 95% CI 0.82-0.92 in Sweden and 0.89, 95% CI 0.81-1.01 in U.S.). Conclusion In two geographically distinct health systems, one in five patients with CKD received potentially inappropriate nephrotoxic medications, mainly NSAIDs. Strategies to increase CKD awareness and physician’s knowledge of drug nephrotoxicity may reduce inappropriate ambulatory prescriptions and prevent iatrogenic kidney injury.

scholarly journals Prevalence of chronic kidney disease stages 3-5 among patients with type 2 diabetes mellitus in Bangladesh

2017 ◽  
Vol 11 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Muhammad Abdur Rahim ◽  
Palash Mitra ◽  
Hasna Fahmima Haque ◽  
Tasrina Shamnaz Samdani ◽  
Shahana Zaman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Glycemic Control ◽  
Significant Risk ◽  
Duration Of Diabetes

Background and objectives: Diabetes mellitus is one of the most common causes of chronic kidney disease (CKD). The prevalence of CKD in type 2 diabetes mellitus (T2DM) in Bangladesh is not well described. The present study aimed to find out the prevalence of CKD stages 3-5 and its risk factors among selected Bangladeshi T2DM patients.Methods: This cross-sectional study was conducted in BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) General Hospital, Dhaka, Bangladesh from July to December 2015. Diagnosed adult T2DM patients were consecutively and purposively included in this study. Pregnant women, patients with diagnosed kidney disease due to non-diabetic etiology, acute kidney injury (AKI), AKI on CKD and patients on renal replacement therapy were excluded. Age, gender, body mass index (BMI) and laboratory parameters were recorded systematically in a predesigned data sheet. Diagnosis of CKD and its stages were determined according to Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines 2012 and estimated glomerular filtration rate (eGFR). Estimated GFR was calculated by using Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (CG) and Chronic Kidney Disease Epidemiology (CKDEPI) creatinine based formula.Results: A total of 400 patients with T2DM of various durations were enrolled in the study. Out of 400 patients, 254 (63.5%), 259 (64.75%) and 218 (54.5%) cases had CKD stages 3-5 according to MDRD, C-G and CKD-EPI equations respectively. CKD was significantly more common in females (p<0.001) and in cases with long duration of diabetes (?5 years; p=0.007). CKD stages 3-5 were significantly associated with hypertension (?2=5.2125, p =0.02) and good control of diabetes (HbA1c <7%) as evidenced by higher proportion of CKD in them (73.3%) compared to those with poor glycemic control (52.1%).Conclusions: More than half of T2DM patients had CKD stages 3-5. Female gender, duration of diabetes and hypertension were significant risk factors and should be emphasized for the prevention of CKD in T2DM. Glycemic control may not reduce CKD in diabetes.IMC J Med Sci 2017; 11(1): 19-24

scholarly journals Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11005
Author(s):  
Hon-Ke Sia ◽  
Chew-Teng Kor ◽  
Shih-Te Tu ◽  
Pei-Yung Liao ◽  
Yu-Chia Chang
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Treatment Failure ◽  
First Year ◽  
Regular Exercise ◽  
Newly Diagnosed ◽  
Baseline Hba1c ◽  
Diabetes Patients

Background Diabetes patients who fail to achieve early glycemic control may increase the future risk of complications and mortality. The aim of the study was to identify factors that predict treatment failure (TF) during the first year in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study conducted at a medical center in Taiwan enrolled 4,282 eligible patients with newly diagnosed T2DM between 2002 and 2017. Data were collected from electronic medical records. TF was defined as the HbA1c value >7% at the end of 1-year observation. A subgroup analysis of 2,392 patients with baseline HbA1c ≥8% was performed. Multivariable logistic regression analysis using backward elimination was applied to establish prediction models. Results Of all study participants, 1,439 (33.6%) were classified as TF during the first year. For every 1% increase in baseline HbA1c, the risk of TF was 1.17 (95% CI 1.15–1.20) times higher. Patients with baseline HbA1c ≥8% had a higher rate of TF than those with HbA1c <8% (42.0 vs 23.0%, p < 0.001). Medication adherence, self-monitoring of blood glucose (SMBG), regular exercise, gender (men), non-insulin treatment, and enrollment during 2010–2017 predicted a significant lower risk of TF in both of the primary and subgroup models. Conclusions Newly diagnosed diabetes patients with baseline HbA1c ≥8% did have a much higher rate of TF during the first year. Subgroup analysis for them highlights the important predictors of TF, including medication adherence, performing SMBG, regular exercise, and gender, in achieving glycemic control.

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