The impact of glycemic load on estimated glomerular filtration rate (eGFR) among people living with HIV (PWH) stratified by diabetes status

Abstract

Objectives We sought to estimate the longitudinal impact of glycemic load on kidney function among people with HIV (PWH) receiving primary HIV care, stratified by diabetes status. Methods We used clinical data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS), a multi-site cohort of adult PWH receiving healthcare in the United States. Kidney function was measured using estimated glomerular filtration rate (eGFR). Glycemic load was defined as five-year average daily glucose and calculated using a Bayesian hierarchical model that incorporated fasting/resting blood glucose and hemoglobin A1C. We used linear mixed models with random intercepts (with each participant considered as a cluster), stratified by diabetes status, and adjusted for age, sex, and diabetes medication prescription to estimate associations between glycemic load and kidney function. Results Our sample included 29,058 unique participants (mean of 8.7 observations per person) with 2,494 participants going from not having to having diabetes over the course of the study. Among 43,569 observations with diabetes, we found that each 10 mg/dL increase in past five-year average daily blood glucose was associated with a 0.29 (95%CI: 0.23, 0.34) mL/min/1.73m2 increase in eGFR after adjusting for age, sex, and diabetes medication. Among 209,564 observations without diabetes, average daily glucose was not associated with eGFR after adjusting for sex and age. Age was associated with a -1.33 and -1.01 mL/min/1.73m2 yearly decline in eGFR for observations with and without diabetes, respectively. Conclusions Glycemic load does not appear particularly predictive for kidney function, regardless of diabetes status, after adjusting for age and sex. Differences in kidney function between PWH with and without diabetes may instead be driven by steeper yearly kidney decline in PWH with diabetes.