Glycemic Management in Chronic Kidney Disease
Summary
Chronic kidney disease (CKD) complicates glycaemic management by altering insulin clearance, glucose filtration and renal gluconeogenesis. As kidney function declines, patients face heightened risk of both hyperglycaemia-related vascular damage and unpredictable hypoglycaemia. Tight glycaemic control must be balanced against the propensity for insulin accumulation and reduced renal excretion of glucose-lowering agents. Individualised targets of glycated haemoglobin (HbA1c) are often adjusted upwards in advanced CKD to minimise hypoglycaemic episodes, while preserving protection against microvascular progression. Emerging markers such as glycated albumin offer complementary insights into short-term control, particularly in patients on peritoneal dialysis. Multidisciplinary care teams integrate dietary modification, pharmacokinetic adjustments and regular monitoring of renal function to reduce cardiovascular and renal endpoints. Ongoing research continues to refine optimal glucose thresholds and to validate novel biomarkers in diverse CKD populations, with the aim of improving both survival and quality of life.
Research from Nature Portfolio
Recent studies have clarified the prognostic value of HbA1c across different stages of CKD. In patients with moderate CKD (stages 3–4), higher HbA1c levels above 9% were linked to increased risk of end-stage renal disease, all-cause mortality and cardiovascular events, whereas this association diminished in stage 5 CKD. This finding underscores the need for stage-specific glycaemic targets. In peritoneal dialysis cohorts, glycated albumin (GA) has emerged as a stronger predictor of two-year mortality than HbA1c. Elevated GA levels (≥20%) were associated with a two- to four-fold increase in mortality risk, while HbA1c showed no consistent relation to survival. These insights support the integration of GA into routine monitoring for dialysis patients and the adjustment of glycaemic targets according to modality and residual renal function.
Glycemic Management in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in glycemic management in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
HbA1c (glycated haemoglobin): Percentage of haemoglobin bound to glucose over two to three months, reflecting average glycaemic exposure.
Glycaemic variability: Fluctuations in blood glucose levels over time, encompassing both peaks of hyperglycaemia and troughs of hypoglycaemia.
eGFR (estimated glomerular filtration rate): Mathematical estimate of kidney filtering capacity, calculated from serum creatinine and demographic factors.
Glycated albumin (GA): Proportion of serum albumin modified by glucose, indicating glycaemic control over the preceding two to three weeks.
References
- Management of diabetes mellitus in patients with chronic kidney disease. Clinical Diabetes and Endocrinology (2015).
- Interactions between kidney disease and diabetes: dangerous liaisons. Diabetology & Metabolic Syndrome (2016).
- 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 (2025).
- Association of HbA1C Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3–4. International Journal of Molecular Sciences (2018).
- Glycated Hemoglobin and Outcomes in Patients with Advanced Diabetic Chronic Kidney Disease. Scientific Reports (2016).
- Glycemic control and survival in peritoneal dialysis patients with diabetes: A 2-year nationwide cohort study. Scientific Reports (2019).
About these summaries
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