HbA1c goal in progressive kidney failure
What is the goal hemoglobin A1c (HbA1c) in patients with progressive kidney failure?
The goal HbA1c in patients with CKD with respect to its effect on hard clinical outcomes has not been clearly established and is beyond the scope of the chapter; from the kidney perspective, glucose control close to normal range is associated with the slowest rate of progression of kidney disease.
The Diabetes Control and Complications Trial (DCCT) randomly assigned approximately 1400 patients with type I diabetes to intensive therapy aimed at maintaining glucose concentrations close to the normal range as compared with conventional therapy.
Intensive therapy reduced the occurrence of microalbuminuria by 39% and albuminuria by 54%.
The Epidemiology of Diabetes Interventions and Complications (EDIC) Study is a long-term, observational study which follows the DCCT cohort of patients to determine the effects of prior DCCT treatment on diabetes complications, particularly nephropathy and macrovascular complications.
It showed that the benefits of intensive diabetes controlled were sustained: after 16 years of follow-up in EDIC (22 years since the start of the DCCT trial), patients originally assigned to intensive glycemic control were significantly less likely to develop impaired kidney function (eGFR < 60 mL/min per 1.73 m 2 ) –3.9% versus 7.6% in the standard therapy group.
Thus a goal HbA1c of close to 7%, particularly in older patients, is a reasonable target and is consistent with the 2012 Kidney Disease Outcomes Quality Initiative and KDIGO guidelines for patients with CKD.
