Maintaining BP and Cholesterol Treatment Goals Decreases CKD Risk in Diabetes

Risk for chronic kidney disease (CKD) in patients with diabetes is reduced with sustained achievement of hemoglobin A_1c (HbA_1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) goals. These findings were published in the Journal of the Endocrine Society.

Investigators from Universidad de los Andes in Columbia sourced data for this study from the Colombian National Registry of Chronic Kidney Disease (NRCKD). Patients diagnosed with diabetes (N=998,790) between 2015 and 2019 were evaluated for CKD risk on the basis of achieving treatment goals. The defined goals were HbA_1c of less than 7%, SBP of less than 130 mm Hg, LDL-C of less than 100 mg/dL, non-high-density lipoprotein cholesterol (HDL-C) of less than 130 mg/dL, and BMI of 18.5 to 25.

The study population comprised 56.6% women, aged mean 59.5 (SD, 13.2) years, 7.2% were Black, with a BMI of 28.2 (SD, 5.3), and 64.9% had hypertension.

Incident CKD occurred among 125,626 patients overall, at a rate of 5.6% in 2017, 5.7% in 2018, and 7.0% in 2019. The rate of CKD was 1.5% higher among men than women and highest overall among patients with an estimated glomerular filtration rate of less than 60 mL/min (12.1%).

Risk for incident CKD was decreased among individuals who achieved the SBP goal alone (adjusted odds ratio [aOR], 0.79; 95% CI, 0.78-0.80); the HbA_1c goal alone (aOR, 0.86; 95% CI, 0.85-0.87); the SBP, HbA_1c, and LDL-C goals (aOR, 0.94; 95% CI, 0.92-0.95); and SBP, HbA_1c, LDL-C, and BMI goals (aHR, 0.88; 95% CI, 0.86-0.91). Meeting non-HDL-C (aOR, 1.05; 95% CI, 1.04-1.07) and LDL-C (aOR, 1.09; 95% CI, 1.07-1.10) goals alone were associated with increased CKD risk.

Stratified by ethnicity, the effect of meeting SBP, HbA_1c, LDL-C, and BMI goals (aOR, 0.72 vs 0.89; P =.002); HbA_1c goals (aOR, 0.75 vs 0.86; P <.001); LDL-C goals (aOR, 1.15 vs 1.08; P =.022); and non-HDL-C goals (aOR, 1.18 vs 1.04; P <.001) were stronger among Black individuals compared with non-Black individuals, respectively. Similarly, the effects of reaching non-HDL-C (P <.001); LDL-C (P <.001); HbA_1c (P =.001); and SBP, HbA_1c, and LDL-C (P =.001) goals on CKD outcomes depended on BMI category.

The rate of achieving SBP, HbA_1c, and LDL-C goals was 5.5%. Among triple-goal achievers, the proportion who also achieved the BMI goal was 1.2%.

The major limitation of this study is the follow-up duration, which is relatively short for the outcome of CKD onset.

“…we found that the successful control of non-HDL cholesterol, but also of HbA_1c, SBP, LDL-C, non-HDL-C and BMI, especially when sustained over time, were strongly associated with lower iCKD [incident CKD] at a country level,” the study authors wrote. “These results have crucial clinical and health policy implications, and support the development of aggressive strategies to control non-HDL-C and other essential treatment goals in the majority of patients with diabetes.”