Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis
BackgroundThe relationship between glycated hemoglobin (HbA1c) levels and mortality outcomes in elderly patients with non-diabetic chronic kidney disease (CKD) has not been well characterized. This study aimed to investigate the correlation between HbA1c levels and all-cause and cardiovascular disea...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1416506/full |
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| author | Lihua Huang Liuliu He Qingfeng Zeng Jinjing Huang Xiaoyan Luo Qiuming Zhong |
| author_facet | Lihua Huang Liuliu He Qingfeng Zeng Jinjing Huang Xiaoyan Luo Qiuming Zhong |
| author_sort | Lihua Huang |
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| description | BackgroundThe relationship between glycated hemoglobin (HbA1c) levels and mortality outcomes in elderly patients with non-diabetic chronic kidney disease (CKD) has not been well characterized. This study aimed to investigate the correlation between HbA1c levels and all-cause and cardiovascular disease (CVD) mortality in elderly individuals with non-diabetic CKD.MethodsData from the NHANES (1999-2018) were analyzed to measure HbA1c levels in whole blood using high-performance liquid chromatography (HPLC). Information on deaths and subsequent details was collected through the National Mortality Index until December 31, 2019. Hazard ratios (HR) and 95% confidence intervals (CIs) for all-cause and CVD mortality were calculated using weighted Cox proportional hazards and restricted cubic spline models.ResultsAmong the 1,931 participants (mean [SE] age, 73.2 [0.2] years; 61.9% female), over a median follow-up period of 7.6 years, a total of 1,003 deaths were observed, including 412 from CVD. HbA1c was divided into four quartiles: Quartile 1 (3.7–5.3%), Quartile 2 (5.4–5.6%), Quartile 3 (5.7–5.8%) as the reference group, and Quartile 4 (5.9–6.4%). Higher risks of all-cause mortality were noted in the lowest and highest HbA1c quartiles, with adjusted HR (95% CI) of 1.48 (1.18–1.87) and 1.31 (1.01–1.70) respectively. For CVD mortality, the lowest quartile showed a significantly increased risk (HR 1.94, 95% CI: 1.29–2.90), but the highest quartile did not significantly differ from the reference, with HR 1.14 (0.73–1.77). The RCS analysis indicated a U-shaped nonlinear relationship between HbA1c levels and all-cause mortality (P = 0.026 for nonlinearity) and a J-shaped nonlinear relationship with CVD mortality (P = 0.035 for nonlinearity).ConclusionThis cohort study suggests that both low and high HbA1c levels are associated with an increased risk of all-cause mortality in elderly patients with non-diabetic CKD. |
| format | Article |
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| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-a95aaed5aa0c4ea19171e2cce7fd36892025-02-11T05:10:21ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-02-011610.3389/fendo.2025.14165061416506Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysisLihua Huang0Liuliu He1Qingfeng Zeng2Jinjing Huang3Xiaoyan Luo4Qiuming Zhong5Department of Clinical Laboratory, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Clinical Laboratory, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Neurology, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Gastroenterology, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Interventional Radiology, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaDepartment of Hospital Pharmacy, The Second Affiliated Hospital of Gannan Medical University, Ganzhou, ChinaBackgroundThe relationship between glycated hemoglobin (HbA1c) levels and mortality outcomes in elderly patients with non-diabetic chronic kidney disease (CKD) has not been well characterized. This study aimed to investigate the correlation between HbA1c levels and all-cause and cardiovascular disease (CVD) mortality in elderly individuals with non-diabetic CKD.MethodsData from the NHANES (1999-2018) were analyzed to measure HbA1c levels in whole blood using high-performance liquid chromatography (HPLC). Information on deaths and subsequent details was collected through the National Mortality Index until December 31, 2019. Hazard ratios (HR) and 95% confidence intervals (CIs) for all-cause and CVD mortality were calculated using weighted Cox proportional hazards and restricted cubic spline models.ResultsAmong the 1,931 participants (mean [SE] age, 73.2 [0.2] years; 61.9% female), over a median follow-up period of 7.6 years, a total of 1,003 deaths were observed, including 412 from CVD. HbA1c was divided into four quartiles: Quartile 1 (3.7–5.3%), Quartile 2 (5.4–5.6%), Quartile 3 (5.7–5.8%) as the reference group, and Quartile 4 (5.9–6.4%). Higher risks of all-cause mortality were noted in the lowest and highest HbA1c quartiles, with adjusted HR (95% CI) of 1.48 (1.18–1.87) and 1.31 (1.01–1.70) respectively. For CVD mortality, the lowest quartile showed a significantly increased risk (HR 1.94, 95% CI: 1.29–2.90), but the highest quartile did not significantly differ from the reference, with HR 1.14 (0.73–1.77). The RCS analysis indicated a U-shaped nonlinear relationship between HbA1c levels and all-cause mortality (P = 0.026 for nonlinearity) and a J-shaped nonlinear relationship with CVD mortality (P = 0.035 for nonlinearity).ConclusionThis cohort study suggests that both low and high HbA1c levels are associated with an increased risk of all-cause mortality in elderly patients with non-diabetic CKD.https://www.frontiersin.org/articles/10.3389/fendo.2025.1416506/fullchronic kidney diseasenon-diabeticmortalityHbA1cNHANES |
| spellingShingle | Lihua Huang Liuliu He Qingfeng Zeng Jinjing Huang Xiaoyan Luo Qiuming Zhong Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis Frontiers in Endocrinology chronic kidney disease non-diabetic mortality HbA1c NHANES |
| title | Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis |
| title_full | Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis |
| title_fullStr | Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis |
| title_full_unstemmed | Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis |
| title_short | Nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non-diabetic chronic kidney disease: a national health and nutrition examination survey analysis |
| title_sort | nonlinear association between glycated hemoglobin levels and mortality in elderly patients with non diabetic chronic kidney disease a national health and nutrition examination survey analysis |
| topic | chronic kidney disease non-diabetic mortality HbA1c NHANES |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1416506/full |
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