Association between time-weighted average glucose concentration or glucose variability and acute kidney injury among coronary artery disease patients with prediabetes.

Abstract

Aims: To validate the effectiveness of intensive glycemic control in preventing acute kidney injury (AKI) among patients with coronary artery disease (CAD) and prediabetes.

Methods: This investigation employed data from the Prospective Registry of the Current Status of Care for Patients with CAD database. Glycemic control was evaluated using the time-weighted average glucose (TWAG) and the glucose coefficient of variation (CV) for each participant. The primary outcome was AKI occurrence.

Results: A total of 2,454 CAD patients with prediabetes were included between January 2022 and June 2023. The mean age was 62.6 ± 10.3 years, with 27.1% female. In univariate analysis, each 1 mmol/L increase in TWAG was associated with a 1.51-fold (95% confidence interval (CI): 1.36-1.68) higher incidence of AKI. After stepwise adjustment for covariates, the odds ratio (OR) remained significant at 1.50 (95% CI: 1.35-1.67). Similarly, glucose CV showed a positive correlation with AKI risk; a 0.1-unit increase in CV was linked to approximately a 44% higher risk. When both TWAG and CV were included simultaneously in the model, each maintained an independent positive association with AKI. Restricted cubic spline analyses revealed a dose-dependent increase in AKI risk with rising TWAG and CV. Subgroup analyses confirmed the positive relationship between TWAG, glucose variability, and AKI risk.

Conclusions: Our study reveals an association between TWAG or CV of glucose and AKI in individuals with both CAD and prediabetes. These findings highlight the potential value of continuous glucose monitoring and managing glycemic variability to reduce AKI risk in this population.