Association between Hemoglobin A1c and Renal Arteriolar Sclerosis in Subjects Presenting without any Apparent Kidney Dysfunction

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  • Matsukuma Yuta
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Tsuchimoto Akihiro
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Masutani Kosuke
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University
  • Ueki Kenji
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Tanaka Shigeru
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Haruyama Naoki
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Okabe Yasuhiro
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Nakamura Masafumi
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Kitazono Takanari
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  • Nakano Toshiaki
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University

Description

<p> Aims: Diabetic kidney disease is a major vascular complication in patients with diabetes mellitus (DM). However, the association between the hemoglobin (Hb)A1c levels, notably the prediabetic levels, and renal pathological changes remains unclear. We investigated the association between the HbA1c levels and renal arteriolar lesions in subjects without any apparent kidney dysfunction using a living kidney donor cohort.</p><p>Methods: Between January 2006 and May 2016, 393 living kidney donors underwent a “zero-time” biopsy at Kyushu University Hospital. The patients were divided into four groups (HbA1c levels ＜5.6%, 5.6%–5.7%, 5.8%–6.4%, and ≥ 6.5%, or diagnosed with DM [DM group]). Renal arteriolar hyalinization and wall thickening were assessed using semi-quantitative grading. We then investigated the association between the HbA1c levels and renal pathological changes.</p><p>Results: 158 (40.2%) patients had arteriolar hyalinization and 148 (37.6%) showed wall thickening. A significant correlation was observed between the HbA1c levels and wall thickening (p for trend ＜0.001). An elevated HbA1c level was significantly associated with wall thickening according to a multivariable logistic analysis in subjects with HbA1c levels of 5.6%–5.7% and 5.8%–6.4%, and the DM group, compared with those with HbA1c levels of ＜5.6% (odds ratio [OR], 1.91; 95% confidence interval [CI]: [1.03–3.54] for 5.6%–5.7%, OR, 1.96; 95% CI: [1.09–3.53] for 5.8%–6.4%, and OR, 2.86; 95% CI: [0.91–9.01] for the DM group), whereas arteriolar hyalinization did not increase within the nondiabetic HbA1c levels.</p><p>Conclusions: Elevated high-normal HbA1c levels are considered to be independent risk factors for arteriolar wall thickening. Subclinical renal arteriolar sclerosis may develop in patients with prediabetic HbA1c levels.</p>

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