In the Journals

Prediabetes does not worsen kidney function

Prediabetes was not associated with deteriorating kidney function or incident albuminuria among adults with hypertension and elevated cardiovascular risk, at least in the short term, according to findings from a secondary analysis of the SPRINT trial.

Miguel Bigotte Vieira

“Diabetes is one of the leading causes of progressive kidney disease, but the association of prediabetes with kidney function decline is less clear,” Miguel Bigotte Vieira, MD, a nephrologist at Centro Hospitalar Universitário Lisboa Norte in Lisbon, Portugal, told Endocrine Today. “The large number of nondiabetic participants, baseline determination of fasting plasma glucose, and detailed follow-up of the SPRINT trial provided a unique opportunity to assess the association of impaired fasting glucose with adverse renal outcomes.”

Vieira and colleagues analyzed data from 9,361 SPRINT participants without diabetes at baseline, stratified by baseline FPG status (mean age, 68 years; 35.5% women; 31.4% black). Participants with an FPG of at least 100 mg/dL were classified as having IFG. Researchers used Cox proportional hazards to estimate the association of IFG with the composite renal outcome in SPRINT, defined by worsening kidney function or incident albuminuria. Worsening kidney function was defined as a decrease in estimated glomerular filtration rate of at least 30% to less than 60 mL/min/1.73 m² in those without chronic kidney disease at baseline or a decrease in eGFR of at least 50% or the development of end-stage renal disease in those with CKD at baseline. Incident albuminuria was defined as a doubling of the ratio of urinary albumin to creatinine from less than 10 mg/g at baseline to at least 10 mg/g during follow-up for all participants.

Within the cohort, 3,879 participants had IFG (41.8%), and 5,424 participants had normoglycemia (58.2%). The composite renal outcome occurred in 221 participants with IFG (5.7%) and 314 participants with normoglycemia (5.8%) during a median follow-up of 3.3 years.

Researchers found that worsening kidney function during follow-up was similar between participants with IFG and normoglycemia (2% vs. 2.1%, respectively), as was the development of incident albuminuria during follow-up among the 4,619 participants determined to be at risk for the condition (7.6% vs. 7.5%, respectively).

Additionally, researchers did not observe an effect modification for the composite renal outcome according to treatment assignment, sex or age. Results persisted after excluding participants with a baseline FPG of at least 126 mg/dL in sensitivity analyses.

João Sérgio Neves

“Our findings suggest that, in individuals with a similar risk profile to that observed in SPRINT, impaired fasting glucose does not appear to be associated with a shorter-term risk of developing significant kidney function decline or albuminuria,” João Sérgio Neves, MD, fellow of endocrinology at Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Portugal, told Endocrine Today. “However, we were not able to evaluate longer-term renal outcomes, and these findings should not detract from the need to address prediabetes in an effort to prevent progression to diabetes and other adverse outcomes.” – by Regina Schaffer

For more information:

Miguel Bigotte Vieira, MD, can be reached at Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz s/n, 1649-035 Lisboa, Portugal; email: mbigottevieira@gmail.com.

Disclosures: The National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke and the National Institute on Aging co-sponsored the SPRINT trial. The authors report no relevant financial disclosures.

Prediabetes was not associated with deteriorating kidney function or incident albuminuria among adults with hypertension and elevated cardiovascular risk, at least in the short term, according to findings from a secondary analysis of the SPRINT trial.

Miguel Bigotte Vieira

“Diabetes is one of the leading causes of progressive kidney disease, but the association of prediabetes with kidney function decline is less clear,” Miguel Bigotte Vieira, MD, a nephrologist at Centro Hospitalar Universitário Lisboa Norte in Lisbon, Portugal, told Endocrine Today. “The large number of nondiabetic participants, baseline determination of fasting plasma glucose, and detailed follow-up of the SPRINT trial provided a unique opportunity to assess the association of impaired fasting glucose with adverse renal outcomes.”

Vieira and colleagues analyzed data from 9,361 SPRINT participants without diabetes at baseline, stratified by baseline FPG status (mean age, 68 years; 35.5% women; 31.4% black). Participants with an FPG of at least 100 mg/dL were classified as having IFG. Researchers used Cox proportional hazards to estimate the association of IFG with the composite renal outcome in SPRINT, defined by worsening kidney function or incident albuminuria. Worsening kidney function was defined as a decrease in estimated glomerular filtration rate of at least 30% to less than 60 mL/min/1.73 m² in those without chronic kidney disease at baseline or a decrease in eGFR of at least 50% or the development of end-stage renal disease in those with CKD at baseline. Incident albuminuria was defined as a doubling of the ratio of urinary albumin to creatinine from less than 10 mg/g at baseline to at least 10 mg/g during follow-up for all participants.

Within the cohort, 3,879 participants had IFG (41.8%), and 5,424 participants had normoglycemia (58.2%). The composite renal outcome occurred in 221 participants with IFG (5.7%) and 314 participants with normoglycemia (5.8%) during a median follow-up of 3.3 years.

Researchers found that worsening kidney function during follow-up was similar between participants with IFG and normoglycemia (2% vs. 2.1%, respectively), as was the development of incident albuminuria during follow-up among the 4,619 participants determined to be at risk for the condition (7.6% vs. 7.5%, respectively).

Additionally, researchers did not observe an effect modification for the composite renal outcome according to treatment assignment, sex or age. Results persisted after excluding participants with a baseline FPG of at least 126 mg/dL in sensitivity analyses.

João Sérgio Neves

“Our findings suggest that, in individuals with a similar risk profile to that observed in SPRINT, impaired fasting glucose does not appear to be associated with a shorter-term risk of developing significant kidney function decline or albuminuria,” João Sérgio Neves, MD, fellow of endocrinology at Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Portugal, told Endocrine Today. “However, we were not able to evaluate longer-term renal outcomes, and these findings should not detract from the need to address prediabetes in an effort to prevent progression to diabetes and other adverse outcomes.” – by Regina Schaffer

For more information:

Miguel Bigotte Vieira, MD, can be reached at Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz s/n, 1649-035 Lisboa, Portugal; email: mbigottevieira@gmail.com.

Disclosures: The National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke and the National Institute on Aging co-sponsored the SPRINT trial. The authors report no relevant financial disclosures.