Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22197
Title: Diabetes and higher HbA1c levels are independently associated with adverse renal outcomes in inpatients following multiple hospital admissions.
Authors: Torkamani, Niloufar;Churilov, Leonid;Robbins, Raymond J;Jerums, George;Beik, V;Radcliffe, N;Patterson, S;Bellomo, Rinaldo;Burns, James D;Hart, Graeme K;Lam, Que T;Power, David A;MacIsaac, Richard J;Johnson, D F;Zajac, Jeffrey;Ekinci, Elif I
Affiliation: Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Centre for Digital Transformation of Health, University of Melbourne
Department of Medicine, The University of Melbourne, Parkville, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Department of Administrative Informatics, Austin Health, Heidelberg, Victoria, Australia
School of Engineering, RMIT University, Melbourne, Victoria, Australia
Clinical Informatics Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Pathology, Austin Health, Heidelberg, Victoria, Australia
Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 22-Oct-2019
EDate: 2019
Citation: Journal of diabetes and its complications 2019; online first: 22 October
Abstract: To assess the association between glycaemic status prior to the first hospital presentation with developing adverse renal outcomes overtime in patients with multiple hospital re-admissions. A prospective observational cohort study. All inpatients aged ≥54 years admitted between 2013 and 16 to a tertiary hospital. We prospectively measured HbA1c levels in all inpatients aged ≥54 years admitted between 2013 and 16. Diabetes was defined as prior documented diagnosis of diabetes and/or HbA1c ≥6.5% (47·5 mmol/L). Included patients had ≥ two admissions (at least 90 days apart), baseline estimated glomerular filtration rate (eGFR) >30 ml/min/1·73m2 and no history of renal replacement therapy. We assessed several renal outcomes: (a) 50% decline in eGFR; (b) rapid decline in renal function (eGFR decline >5 mL/min/1·73m2/year) and (c) final eGFR<30 ml/min/1·73m2. Of 4126 inpatients with a median follow-up of 465 days (254, 740), 26% had diabetes. The presence of diabetes was associated with higher odds of (a) 50% decline in eGFR (OR = 1·42;95% CI:1·18-1·70;p < 0·001); (b) rapid decline in renal function (OR = 1·40;95%CI:1·20-1·63;p < 0·001), and (c) reaching eGFR<30 ml/min/1.73m2 (OR = 1·25;95%CI:1·03-1·53;p < 0·05). Every 1% (11 mmol/L) increase in baseline HbA1c was associated with significantly greater odds of (a) >50% decline in eGFR (OR = 1·07;95% CI:1·01-1·4;p < 0·05) and (b) rapid decline in renal function (OR = 1·11;95% CI:1·05-1·18;p < 0·001). In patients with ≥two admissions, the presence of diabetes and higher HbA1c levels were strongly and independently associated with adverse renal outcomes at follow up. Such patients are at high risk of relatively rapid deterioration in renal function and a logical target for structured preventive interventions.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22197
DOI: 10.1016/j.jdiacomp.2019.107465
ORCID: 0000-0003-3983-0581
0000-0003-3933-5708
0000-0003-2372-395X
PubMed URL: 31735639
Type: Journal Article
Subjects: Diabetes
Hospitalised patients
Renal disease
Appears in Collections:Journal articles

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