{"doi":"10.1053/j.ajkd.2023.03.007","title":"Long-term Visit-to-Visit Variability in Hemoglobin A1c and Kidney-Related Outcomes in Persons With Diabetes","abstract":null,"journal":"American Journal of Kidney Diseases","year":2023,"id":643454,"datarank":0.5050943744979712,"base_score":3.367295829986474,"endowment":3.367295829986474,"self_citation_contribution":0.5050943744979712,"citation_network_contribution":0.0,"self_endowment_contribution":0.5050943744979712,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":28,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1320706,"name":"Shujie Dong","orcid":null,"position":1,"is_corresponding":false},{"id":856089,"name":"Edouard L. Fu","orcid":"0000-0002-9698-6825","position":2,"is_corresponding":false},{"id":124090,"name":"Arvid Sjölander","orcid":null,"position":3,"is_corresponding":false},{"id":73169,"name":"Morgan E. Grams","orcid":"0000-0002-4430-6023","position":4,"is_corresponding":false},{"id":405218,"name":"Elizabeth Selvin","orcid":"0000-0002-3539-2070","position":5,"is_corresponding":false},{"id":1674240,"name":"Juan Jesus Carrero","orcid":null,"position":6,"is_corresponding":false},{"id":797247,"name":"Yang Xu","orcid":"0000-0001-8997-5995","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Long-term Visit-to-Visit Variability in Hemoglobin A1c and Kidney-Related Outcomes in Persons With Diabetes","abstract":"<h4>Rationale & objective</h4>To characterize associations between long-term visit-to-visit variability of hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) and risk of adverse kidney outcomes in patients with diabetes.<h4>Study design</h4>Observational study.<h4>Setting & participants</h4>93,598 adults with diabetes undergoing routine care in Stockholm, Sweden.<h4>Exposures and predictors</h4>Categories of baseline and time-varying HbA<sub>1c</sub> variability score (HVS, the percentage of total HbA<sub>1c</sub> measures that vary by>0.5% [5.5mmol/mol] during a 3-year window): 0-20%, 21%-40%, 41%-60%, 61%-80%, and 81%-100%, with 0-20% as the reference group.<h4>Outcome</h4>Chronic kidney disease (CKD) progression (composite of>50% estimated glomerular filtration rate [eGFR] decline and kidney failure), acute kidney disease (AKI by clinical diagnosis or transient creatinine elevations according to KDIGO criteria), and worsening of albuminuria.<h4>Analytical approach</h4>Multivariable Cox proportional hazards regression.<h4>Results</h4>Compared with persons showing low HbA<sub>1c</sub> variability (HVS 0-20%), any increase in variability was associated with a higher risk of adverse kidney outcomes beyond mean HbA<sub>1c</sub>. For example, for patients with a baseline HbA<sub>1c</sub> variability of 81%-100%, the adjusted HR was 1.6 (95% CI, 1.47-1.74) for CKD progression, 1.23 [1.16-1.3] for AKI, and 1.28 [1.21-1.36] for worsening of albuminuria. The results were consistent across subgroups (diabetes subtypes, baseline eGFR, or albuminuria categories), in time-varying analyses and in sensitivity analyses including time-weighted average HbA<sub>1c</sub> or alternative metrics of variability.<h4>Limitations</h4>Observational study, limitations of claims data, lack of information on diet, body mass index, medication changes, and diabetes duration.<h4>Conclusions</h4>Higher long-term visit-to-visit HbA<sub>1c</sub> variability is consistently associated with the risks of CKD progression, AKI, and worsening of albuminuria.<h4>Plain-language summary</h4>The evidence for current guideline recommendations derives from clinical trials that focus on a single HbA<sub>1c</sub> as the definitive measure of efficacy of an intervention. However, long-term visit-to-visit fluctuations of HbA<sub>1c</sub> may provide additional value in the prediction of future kidney complications. We evaluated the long-term fluctuations in glycemic control in almost 100,000 persons with diabetes undergoing routine care in Stockholm, Sweden. We observed that higher long-term HbA<sub>1c</sub> fluctuation is consistently associated with the risks of chronic kidney disease progression, worsening of albuminuria and acute kidney injury. This finding supports a role for long-term glycemic variability in the development of kidney complications and illustrates the potential usefulness of this metric for risk stratification at the bedside beyond a single HbA<sub>1c</sub> test.","is_dataset_classified":null,"base_score":3.367295829986474,"endowment":3.367295829986474,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37182597","pmcid":"PMC10524363","openalex_id":"https://openalex.org/W4376272670","authors":[],"funders":[{"funder_name":"National Institutes of Health","grant_id":"K24 HL155861","title":null},{"funder_name":"National Institutes of Health","grant_id":"R01 DK100446","title":null},{"funder_name":"National Institutes of Health","grant_id":"R01 DK115534","title":null},{"funder_name":"Vetenskapsrådet","grant_id":"2019-01059","title":null},{"funder_name":"National Institutes of Health","grant_id":"5K24HL155861-04","title":"Prevention and Treatment of Cardiovascular Disease in Patients with Chronic Kidney Disease: Patient-Oriented Research and Mentoring"},{"funder_name":"National Institutes of Health","grant_id":"5R01DK100446-02","title":"Chronic Kidney Disease Prognosis Consortium"},{"funder_name":"National Institutes of Health","grant_id":"2R01DK115534-06","title":"Maximizing The Benefit of Therapy in CKD"}],"total_grants":7,"fwci":4.1765,"citation_percentile":0.95604995,"influential_citations":0,"citation_trend":[{"year":2023,"count":2},{"year":2024,"count":8},{"year":2025,"count":8},{"year":2026,"count":10}],"oa_status":"bronze","license":"Elsevier TDM","oa_locations":[{"url":"http://www.ajkd.org/article/S0272638623006285/pdf","host_type":"journal"},{"url":"http://www.ajkd.org/article/S0272638623006285/pdf","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S0272638623006285?httpAccept=text/xml","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S0272638623006285?httpAccept=text/plain","host_type":"publisher"},{"url":"https://doi.org/10.1053/j.ajkd.2023.03.007","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37182597","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10524363","host_type":"repository"},{"url":"https://hdl.handle.net/1887/3729564","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10524363/pdf/nihms-1900920.pdf","host_type":"repository"},{"url":"https://scholarlypublications.universiteitleiden.nl/access/item%3A3729565/view","host_type":"repository"}],"fields_of_study":["Diabetes Treatment and Management","Diabetes Management and Research","Medication Adherence and Compliance","03 medical and health sciences","0302 clinical medicine","Adult","Humans","Albuminuria","Disease Progression","Diabetes Mellitus","Kidney","Renal Insufficiency, Chronic","Glycated Hemoglobin","Acute Kidney Injury","Glomerular Filtration Rate","Hemoglobin, Sickle"],"mesh_terms":["Adult","Albuminuria","Diabetes Mellitus","Glomerular Filtration Rate","Glycated Hemoglobin","Hemoglobin, Sickle","Humans","Kidney","Disease Progression","Renal Insufficiency, Chronic","Acute Kidney Injury"],"keywords":["Medicine","Albuminuria","Kidney disease","Renal function","Diabetes mellitus","Internal medicine","Body mass index","Proportional hazards model","Creatinine","Observational study","Type 2 diabetes","Intensive care medicine","Endocrinology","Diabetes","Aki","Ckd Progression","Hba(1c) Variability","Worsening Of Albuminuria","Adult","Glycated Hemoglobin","Hemoglobin, Sickle","Acute Kidney Injury","Kidney","Disease Progression","Humans","Renal Insufficiency, Chronic","Glomerular Filtration Rate"],"sdg_mappings":[{"sdg_number":2,"sdg_label":"2. 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