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Glycemic Metrics and Targets in Kidney Disease

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Endocrine Disorders in Kidney Disease

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Abstract

While intensive glycemic management has been shown to delay the onset and progression of kidney disease, optimal glycemic targets in the setting of diabetic kidney disease (DKD) remain controversial. A variety of factors associated with kidney disease and/or the uremic state can impact the accuracy and interpretability of currently available glycemic measures. Alterations in erythrocyte survival time, hemoglobin concentrations, and other factors likely bias glycated hemoglobin (A1C) values to lower levels in people with DKD, yet A1C remains a key monitoring parameter recommended to inform the glycemic management of people with DKD. The optimal A1C target for patients with DKD, however, remains controversial. Evidence suggests that overly aggressive A1C targets in advanced DKD may contribute to increased risk of mortality. Several observational studies have reported a “U-shaped” relationship between A1C and mortality, with current epidemiological data suggesting that relatively conservative A1C targets may be desirable. Patients with DKD are additionally known to be at particular risk for hypoglycemia, and hypoglycemia avoidance is an important priority when establishing glycemic targets. Given the emphasis on individualized glycemic targets in all people with diabetes, and when considering the interpretive difficulties at play in the setting of DKD, patient-derived glucose data obtained via self-monitoring of blood glucose remains a crucial tool to consolidate therapeutic goals. With additional study and experience, other current and evolving methods of glycemic assessment may prove beneficial in the management of overall glycemic control in the setting of kidney disease.

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Author information

Authors and Affiliations

  1. Department of Pharmacotherapy, Washington State University, Spokane, WA, USA

    Joshua J. Neumiller

  2. Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle, WA, USA

    Irl B. Hirsch

Authors
  1. Joshua J. Neumiller
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  2. Irl B. Hirsch
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Correspondence to Joshua J. Neumiller .

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Editors and Affiliations

  1. Division of Nephrology and Hypertension, Departments of Medicine and Public Health, University of California Irvine, School of Medicine, Orange, CA, USA

    Connie M. Rhee

  2. Division of Nephrology and Hypertension, Departments of Medicine, Pediatrics, Public Health, and Nursing Sciences, University of California Irvine, School of Medicine, Orange, CA, USA

    Kamyar Kalantar-Zadeh

  3. Division of Endocrinology, Diabetes, and Hypertension, Departments of Medicine and Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Gregory A. Brent

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Neumiller, J.J., Hirsch, I.B. (2019). Glycemic Metrics and Targets in Kidney Disease. In: Rhee, C., Kalantar-Zadeh, K., Brent, G. (eds) Endocrine Disorders in Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-97765-2_4

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  • DOI: https://doi.org/10.1007/978-3-319-97765-2_4

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