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

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 31; no. 8; pp. 1215 - 1224
• Main Authors: Masutani, Kosuke, Matsukuma, Yuta, Kitazono, Takanari, Nakano, Toshiaki, Tsuchimoto, Akihiro, Ueki, Kenji, Haruyama, Naoki, Okabe, Yasuhiro, Nakamura, Masafumi, Tanaka, Shigeru
• Format: Journal Article
• Language: English
• Published: Japan Japan Atherosclerosis Society 01.08.2024
• Subjects: Adult; Arterioles - pathology; Diabetic Nephropathies - blood; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - etiology; Female; Follow-Up Studies; Glycated Hemoglobin - analysis; Glycated Hemoglobin - metabolism; Hemoglobin A1c; Humans; Kidney - pathology; Kidney transplantation; Living Donors; Living kidney donor; Male; Middle Aged; Original; Prognosis; Renal arteriolar sclerosis; Sclerosis; Zero-time biopsy; Zero-time biopsy; Renal arteriolar sclerosis; Hemoglobin A1c; Living kidney donor; Kidney transplantation
• ISSN: 1340-3478; 1880-3873; 1880-3873
• DOI: 10.5551/jat.64236

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.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.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.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.