Diabetes, obesity & metabolism 2017 04 21() doi 10.1111/dom.12976
Variability in HbA1c and blood pressure (BP) is associated with the risk of diabetic kidney disease (DKD). No evidence exists on the role of variability in lipids or serum uric acid (UA), or the interplay between the variability of different parameters, on renal outcomes.
MATERIALS AND METHODS
Within the AMD Annals database we identified patients with ≥5 measurements of HbA1c, SBP and DBP, total-, HDL- and LDL- cholesterol, triglycerides, and UA. Patients were followed-up for up to 5 years. The impact of measures of variability on the risk of DKD was investigated by Cox regression analysis and recursive partitioning techniques.
4,231 patients were evaluated for development of albuminuria and 7,560 for decreased eGFR (<60 ml/min/1.73 m(2) ). A significantly higher risk of developing albuminuria was associated with variability in HbA1c (upper quartile HR = 1.3; 95%CI 1.1-1.6). Variability in SBP, DBP, HDL-C, LDL-C and UA predicted the decline in eGFR, the association with UA variability being particularly strong (upper quartile HR = 1.8; 95%CI 1.3-2.4). The concomitance of high variability in HbA1c, and HDL-C conferred the highest risk of developing albuminuria (HR = 1.47; 95%CI 1.17-1.84), while a high variability in UA (HR = 1.54; 95%CI 1.19-1.99) or PAD (HR = 1.47; 95%CI 1.11-1.94) conferred the highest risk of decline in eGFR. CONCLUSIONS
The variability of several parameters influences the development of DKD, having different impact on albuminuria development and on the decline in GFR.