Newly diagnosed prediabetes in a nephroprotection program for patients with nondialysis- dependent chronic kidney disease

Abstract

Introduction: nephroprotection programs for patients with non-dialysis-dependent chronic kidney disease (NDCKD) often order glycosylated hemoglobin (HbA1c) to evaluate metabolic control and adherence to antidiabetic treatment in patients with prediabetes or diabetes mellitus. However, whether its systematic measurement in patients with NDCKD without a prediabetes or diabetes diagnosis is a cost-effective procedure is unclea.

Materials and methods: all patients who were referred to the nephrology service at Universidad de Caldas for elevated creatinine were included. Those who met the criteria for NDCKD were selected, and those with a prior diagnosis of prediabetes or diabetes mellitus were excluded. As part of the nephroprotection program, tests were ordered for all patients, including glycosylated hemoglobin, regardless of their glomerular filtration rate. Prediabetes was defined as a glycosylated hemoglobin between 5.7 and 6.4%, and diabetes mellitus was defined as a value greater than or equal to 6.5.

Results: over a period of six years, 1,701 patients were evaluated. Of these, 1,135 were excluded for different reasons, and 566 patients were ultimately analyzed. Neither diabetes nor prediabetes were found in 350 patients (61.83%) (Group 1), 203 patients (35.86%), had newly diagnosed prediabetes (Group 2), and 13 patients (2.29%) had newly diagnosed diabetes (Group 3). The main cause of chronic kidney disease in the three groups was unknown etiology, followed by hypertensive nephrosclerosis. Group 3 was excluded from the statistical analysis due to its small size. Patients with prediabetes were older and had a higher body mass index, creatinine level, fasting blood sugar and glycosylated hemoglobin, as well as a lower glomerular filtration rate. There were no significant differences between the groups as far as hemoglobin, vitamin D or vitamin B12 levels.

Conclusions: the prevalence of prediabetes in patients with NDCKD is high, affecting approximately one out of three patients. Including glycosylated hemoglobin within a nephroprotection program’s set of tests allows early diagnosis of prediabetes, facilitating timely interventions to prevent progression to diabetes mellitus and potentially reduce the risk of renal and cardiovascular complications.