Prognostic association of HbA1c and fasting plasma glucose with reduced kidney function in subjects with and without diabetes mellitus. Results from a population-based cohort study from Germany

Prev Med. 2013 Nov;57(5):596-600. doi: 10.1016/j.ypmed.2013.08.002. Epub 2013 Aug 13.


Objective: To determine the risk for incident reduced kidney function (RKF) of subjects with pre-diabetes (impaired fasting glucose (IFG, 5.6-6.9 mmol/L)) or HbA1c-defined pre-diabetes (5.7%-6.4%) and to determine dose-response relationships of fasting glucose and HbA1c with RKF in subjects with manifest diabetes mellitus.

Method: In a German population-based cohort, recruited 2000-2002 with ages 50-74 years, log-binomial regression was used to estimate relative risks (RR) with 95% confidence intervals (95%CI) and restricted cubic splines to plot dose-response relationships.

Results: During 8 years of follow-up, 678 of 3538 study participants developed primary RKF. Although RKF risk factor prevalences and RKF incidences were higher in subjects with pre-diabetes than in subjects with normal FPG and/or HbA1c levels, an increased risk did not persist after adjusting for established cardiovascular risk factors (RR(IFG): 0.97 (95% CI: 0.75-1.25) and RR(HbA1c-defined pre-diabetes): 1.03 (95% CI: 0.86-1.23)). In subjects with manifest diabetes, RKF risk increased linearly to a more than three-fold risk with increasing fasting glucose and HbA1c levels (at HbA1c>6.4%).

Conclusion: This study provides further evidence that pre-diabetes may not directly contribute to the development of kidney disease. Subjects with pre-diabetes might nevertheless profit from preventive efforts reducing their cardiovascular risk profile because cardiovascular and kidney disease share common risk factors.

Keywords: BMI; Blood glucose; CKD; Cohort study; Diabetes mellitus, type 2; Epidemiology; FPG; HbA(1c); IFG; IGT; Impaired fasting glucose; Impaired glucose tolerance; Kidney disease; OGTT; OR; Odds ratio; Prediabetes; RKF; RR; Relative risk; body mass index; chronic kidney disease; fasting plasma glucose; glycated hemoglobin A(1c); oral glucose tolerance test; reduced kidney function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Glucose / metabolism*
  • Cohort Studies
  • Creatinine / blood
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetic Nephropathies / blood*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Germany
  • Glomerular Filtration Rate / physiology
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Kidney Function Tests*
  • Male
  • Middle Aged
  • Prediabetic State / blood*
  • Prognosis
  • Risk Factors


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Creatinine