The Association between Glycated Hemoglobin and Estimated Glomerular Filtration Rate in Patients with Type 2 Diabetes based on the Hemoglobin Status

Document Type : Original Article


1 Clinical Research Development center, Shahid Mohammadi Hospital,,Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Endocrinology and Metabolism Research Center,, Hormozgan University of Medical Sciences, Bandar Abbas, Iran


Background:The aim of the present study was to examine the association between hemoglobin A1C (HbA1C( and eGFR in patients with type 2 diabetes (T2D).
Methods:This cross-sectional study was conducted on 802 patients with T2D visiting Abu Reyhan Clinic of Shahid Mohammadi Hospital in Bandar Abbas, Iran. eGFR was determined using MDRD and EPI methods. The association between two levels of HbA1C (≤8% and >8%) and two levels of GFR (≤60% and >60%) were assessed in total population, and separately, in men and women using linear regression model.
Results:The mean ± SD age of the study population (27.7% male) was 53.5 ± 5.5 years. Based on the multivariable adjusted model, in subjects with HbA1C >8%, there was a negative association between HbA1C and eGFR-EPI (β = -0.14) and eGFR-MDRD (β = -0.12), (p <0.05). However, there was no significant relationship between HbA1C and eGFR in individuals with HbA1C ≤8%. Also, no significant association was found between HbA1C and eGFR as categorical variables (based on the two categories of eGFR ≤60 and >60). An inverse association was observed between GFR ≤60 and HbA1C >8% in women based on the Hb classification. This inverse association was found between HbA1C >8% and eGFR-EPI (β = -0.76) and eGFR-MDRD (β = -0.78) in women with Hb >12 mg/dl (p <0.01).
Conclusion:According to the results, the higher level of HbA1C can be associated with decreased eGFR level. This negative association was mostly observed between HbA1C >8% and GFR ≤60 in T2DM female patients without anemia (Hb>12). It seems that monitoring kidney function by eGFR estimation is a necessary action in patients with T2D with high HbA1C levels.


  1. Prabhu S, Pawade Y, Dhamnaskar R, Karamchandani R. Association of HbA1c with kidney dysfunction in diabetes mellitus and cardiovascular diseases. People’s Journal of Scientific Research 2016; 9(2):1-6.
  2. American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes 2015; 33(2):97-111.
  3. Jerums G, Panagiotopoulos S, Premaratne E, MacIsaac RJ. Integrating albuminuria and GFR in the assessment of diabetic nephropathy. Nat Rev Nephrol 2009; 5(7):397-406.
  4. Levey AS, Becker C, Inker LA. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA 2015; 313(8):837-46.
  5. Bjornstad P, Maahs DM, Wadwa RP, Pyle L, Rewers M, Eckel RH, et al. Plasma triglycerides predict incident albuminuria and progression of coronary artery calcification in adults with type 1 diabetes: the coronary artery calcification in type 1 diabetes study. J Clin Lipidol 2014; 8(6):576-83.
  6. Ninomiya T, Perkovic V, de Galan BE, Zoungas S, Pillai A, Jardine M, et al. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. J Am Soc Nephrol 2009; 20(8):1813-21.
  7. Bjornstad P, Cherney DZ, Maahs DM. Update on estimation of kidney function in diabetic kidney disease. Curr Diab Rep 2015; 15(9):57.
  8. Molitch ME, Steffes M, Sun W, Rutledge B, Cleary P, de Boer IH, et al. Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study. Diabetes Care 2010; 33(7):1536-43.
  9. Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med 2003; 348(23):2285-93.
  10. Lee SY, Choi ME. Urinary biomarkers for early diabetic nephropathy: beyond albuminuria. Pediatr Nephrol 2015; 30(7):1063-75.
  11. Stevens LA, Fares G, Fleming J, Martin D, Murthy K, Qiu J, et al. Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease. J Am Soc Nephrol 2005; 16(8):2439-48.
  12. de Jong PE, Halbesma N, Gansevoort RT. Screening for early chronic kidney disease--what method fits best? Nephrology Dialysis Transplantation 2006; 21(9):2358-61.
  13. Kang SH, Jung DJ, Choi EW, Cho KH, Park JW, Do JY. HbA1c levels are associated with chronic kidney disease in a non-diabetic adult population: a nationwide survey (KNHANES 2011-2013). PLoS One 2015; 10(12):e0145827.
  14. Lee CL, Li TC, Lin SY, Wang JS, Lee IT, Tseng LN, et al. Dynamic and dual effects of glycated hemoglobin on estimated glomerular filtration rate in type 2 diabetic outpatients. Am J Nephrol 2013; 38(1):19-26.
  15. Rigalleau V, Lasseur C, Raffaitin C, Perlemoine C, Barthe N, Chauveau P, et al. Glucose control influences glomerular filtration rate and its prediction in diabetic subjects. Diabetes Care 2006; 29(7):1491-5.
  16. Selvin E, Ning Y, Steffes MW, Bash LD, Klein R, Wong TY, et al. Glycated hemoglobin and the risk of kidney disease and retinopathy in adults with and without diabetes. Diabetes 2011; 60(1):298-305.
  17. Lee CL, Chen CH, Wu MJ, Tsai SF. The variability of glycated hemoglobin is associated with renal function decline in patients with type 2 diabetes. Ther Adv Chronic Dis 2020; 11:2040622319898370.
  18. Subramanyam K, Gosavi S, Tenneti D, Murgod R. Evaluation of the Role of HBA1c in Chronic Kidney Disease. Journal of Clinical and Diagnostic Research 2018; 12(7):BC01-4.
  19. Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern Med 2014; 29(2):388-94.
  20. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9):604-12.
  21. Borg R, Persson F, Siersma V, Lind B, de Fine Olivarius N, Andersen CL. Interpretation of HbA1c in primary care and potential influence of anaemia and chronic kidney disease: an analysis from the Copenhagen Primary Care Laboratory (CopLab) database. Diabet Med 2018; 35(12):1700-6.
  22. Ceriello A, De Cosmo S, Rossi MC, Lucisano G, Genovese S, Pontremoli R, et al. Variability in HbA1c, blood pressure, lipid parameters and serum uric acid, and risk of development of chronic kidney disease in type 2 diabetes. Diabetes Obes Metab 2017; 19(11):1570-8.
  23. Ford ES, Cowie CC, Li C, Handelsman Y, Bloomgarden ZT. Iron-deficiency anemia, non-iron-deficiency anemia and HbA1c among adults in the US. J Diabetes 2011; 3(1):67-73.
  24. Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol 2004; 112(3):126-8.