Rationale & objective: HbA_1c is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis dependent CKD population remains unknown.
理论与目的: HbA _1c 被广泛用于评估血糖，但对慢性肾脏疾病(CKD)患者的可靠性较低。糖化白蛋白(GA)的补充使用，以改善血糖监测和风险分层的兴趣日益增长。然而，GA 是否与非透析依赖性 CKD 患者的临床结果相关仍不得而知。

Study design: Prospective cohort study.

Setting: & Participants: 3110 participants with CKD from the Chronic Renal Insufficiency Cohort study.
研究对象: 3110名慢性肾脏病患者，来自慢性肾功能衰竭队列研究。

Exposure: Baseline GA levels.

Outcomes: Incident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality.
结果: 事件终末期肾病(ESKD) ，心血管疾病(CVD)事件和全因死亡率。

Analytical approach: Cox proportional hazards regression.
分析方法: Cox 比例风险回归。

Results: Participant characteristics included mean age 59.0 (SD 10.8) years; 1357 (43.6%) female; 1550 (49.8%) with diabetes. The median GA was 18.7 (interquartile range, 15.8-23.3)%. During an average 7.9-year follow-up, there were 980 ESKD events, 968 CVD events, and 1084 deaths. Higher GA levels were associated with greater risks of all outcomes, regardless of diabetes status: hazard ratios for ESKD, CVD, and death among participants with the highest quartile compared with quartile 2 (reference) were 1.42 (95%CI, 1.19-1.69), 1.67 (CI, 1.39-2.01), and 1.63 (CI, 1.37-1.94), respectively. The associations with CVD and death appeared J-shaped, with increased risk also seen at the lowest GA levels. Among patients with coexisting CKD and diabetes, the associations of GA with outcomes remained significant even after adjusting for HbA_1c. For each outcome, we observed a significant increase in the fraction of new prognostic information when both GA and HbA_1c were added to models.
结果: 参与者的特征包括平均年龄59.0(SD 10.8)岁; 1357(43.6%)女性; 1550(49.8%)糖尿病患者。中位遗传四分差为18.7% (15.8-23.3%)。在平均7.9年的随访中，有980例 ESKD 事件，968例心血管疾病事件和1084例死亡。更高的 GA 水平与所有结局的风险更高有关，无论糖尿病状态如何: 与四分位数2(参考)相比，四分位数最高的参与者 ESKD，CVD 和死亡的风险比分别为1.42(95% CI，1.19-1.69) ，1.67(CI，1.39-2.01)和1.63(CI，1.37-1.94)。与心血管疾病和死亡的相关性呈 J 型，在最低 GA 水平也可见风险增加。在同时存在 CKD 和糖尿病的患者中，即使调整了 HbA _1c. ，GA 与结局的关联仍然显着，对于每个结果，当 GA 和 HbA _1c 被添加到模型中时，我们观察到新预后信息的分数显着增加。

Limitations: Lack of longitudinal GA measurements; HbA_1c measurements were largely unavailable in participants without diabetes.

Conclusions: Among patients with CKD, GA levels were independently associated with risks of ESKD, CVD, and mortality, regardless of diabetes status. GA added prognostic value to HbA_1c among patients with coexisting CKD and diabetes.
结论: 在 CKD 患者中，GA 水平与 ESKD、 CVD 和死亡率的风险独立相关，与糖尿病状态无关。GA 对慢性肾脏病合并糖尿病患者 HbA _1c 的预后价值。