Supplementary Online Content Shurraw S, Hemmelgarn B, Lin M, et al. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study. Arch Intern Med. 2011;303(21):1920-1927. efigure. Smoothed cubic spline of the relation between baseline A1C and index egfr. etable 1. Characteristics of patients included in and excluded from the study. etable 2. Adjusted risk of adverse outcomes among people with stage 3 CKD, using A1C as a time-varying covariate. etable 3. Adjusted risk of adverse outcomes among people with stage 4 CKD, using A1C as a time-varying covariate. This supplementary material has been provided by the authors to give readers additional information about their work.
efigure 1: Smoothed cubic spline of the relation between baseline A1C and index egfr The red line represents the smoothed cubic spline of mean A1C, and blue lines represent the 95% confidence interval.
etable 1: Characteristics of patients included in and excluded from the study With A1C measurement n=23296 Without A1C measurement n=8041 P Age, mean (SD), y 71.7 (11.4) 74.5 (11.8) <.0001 Female 12880 (55) 4651 (58) <.0001 Socioeconomic status* Assistance Normal Subsidy 775 (3) 6918 (30) 15603 (67) 252 (3) 1848 (23) 5941 (74) <.0001 Index egfr 46.8(10.5) 46.3 (10.6) <.0001 15-29.9 2141 (9) 755 (9) 0.595 30-59.9 21155(91) 7286 (91) Comorbidities Cancer 2449 (11) 1201 (15) <.0001 Cardiovascular disease 2524 (11) 1283 (16) <.0001 Heart failure 4516 (19) 2241 (28) <.0001 COPD 5493 (24) 2497 (31) <.0001 Dementia 1544 (7) 1001 (12) <.0001 HIV 4 (0.02) 1 (0.01) 0.999* Metastatic cancer 312 (1) 251 (3) <.0001 Myocardial infarction 2887 (12) 1316 (16) <.0001 Mild liver disease 418 (2) 215 (3) <.0001 Moderate/severe liver disease 104 (0.5) 79 (1) <.0001 Paraplegia 355 (2) 196 (2) <.0001 Peptic ulcer disease 954 (4) 454 (6) <.0001 Peripheral vascular disease 2069 (9) 965 (12) <.0001 Rheumatological disease 618 (3) 307 (4) <.0001 Income ** Below Poverty Line 2175 (9) 732 (9) <.0001 Between poverty line and Alberta 12529 (54) 4533 (57) median income Higher than median 8419 (36) 2684 (34) Values are n(%) or mean (SD) as appropriate. *Exact test *Socioeconomic status: Assistance refers to participants with health insurance premium paid under a program sponsored by Alberta Employment, Immigration and Industry. Subsidy refers to participants who pay less than the full premium or no premium to Alberta Health and Wellness, or in the premium is subsidized though a Government Sponsored Program. Normal refers to all other participants. ** median income was unavailable for 265 participants. The Alberta median individual employment income was $29,500/y in 2005. The poverty line is $14,914/y for rural, $18,659/y for urban (except Calgary and Edmonton), and $21,666/y for Calgary and Edmonton.
etable 2: Adjusted risk of adverse outcomes among people with stage 3 CKD, using A1C as a time-varying covariate A1C <7.0 7.0 9.0 >9.0 All-cause mortality Adjusted HR (95% CI) 1 1.16 (1.07, 1.25) 1.38 (1.25, 1.51) First episode of all-cause hospitalization Adjusted HR (95% CI) 1 1.06 (1.01, 1.11) 1.29 (1.23, 1.36) Myocardial infarction Adjusted HR (95% CI) 1 1.30 (1.14, 1.49) 1.88 (1.62, 2.19) Stroke Adjusted HR (95% CI) 1 1.09 (0.93, 1.27) 1.71 (1.42, 2.06) Heart failure Adjusted HR (95% CI) 1 1.30 (1.16, 1.46) 1.58 (1.40, 1.80) ESRD Adjusted HR (95% CI) 1 1.34 (0.90, 1.98) 2.03 (1.39, 2.95) Sustained doubling of serum creatinine* Adjusted HR (95% CI) 1 1.25 (1.09, 1.44) 1.53 (1.32, 1.76) ESRD, end-stage renal disease. *Doubling of serum creatinine could not be assessed for 330 pts because their creatinine was measured only at index date. Models were adjusted for age, gender, index egfr, individual health insurance premium level, median neighborhood income, comorbidity and residence location. All-cause
etable 3: Adjusted risk of adverse outcomes among people with stage 4 CKD, using A1C as a time-varying covariate A1C <7.0 7.0 9.0 >9.0 All-cause mortality Adjusted HR (95% CI) 1 1.09 (0.93, 1.28) 1.27 (1.04, 1.55) P for trend <0.0001 First episode of all-cause hospitalization Adjusted HR (95% CI) 1 1.05 (0.93, 1.19) 1.05 (0.92, 1.20) Myocardial infarction Adjusted HR (95% CI) 1 1.31 (0.90, 1.91) 1.85 (1.24, 2.75) Stroke Adjusted HR (95% CI) 1 1.01 (0.66, 1.57) 1.69 (1.04, 2.74) Heart failure Adjusted HR (95% CI) 1 1.18 (0.93, 1.50) 1.11 (0.83, 1.49) ESRD Adjusted HR (95% CI) 1 1.15 (0.88, 1.50) 1.38 (1.05, 1.81) Sustained doubling of serum creatinine* Adjusted HR (95% CI) 1 0.87 (0.67, 1.13) 1.63 (1.25, 2.11) ESRD, end-stage renal disease. *Doubling of serum creatinine could not be assessed for 19 pts because their creatinine was measured only at index date. Models were adjusted for age, gender, index egfr, individual health insurance premium level, median neighborhood income, comorbidity and residence location