Association between hemoglobin glycation index and carotid plaques in non-dialysis CKD stage 3-5 patients: a retrospective cross-sectional study.

Purpose: Carotid atherosclerosis is a major cardiovascular complication in patients with chronic kidney disease (CKD). The hemoglobin glycation index (HGI) has been linked to glycation stress and vascular inflammation, which may contribute to atherosclerosis. However, its relationship with carotid plaque in patients with CKD remains unclear. This study aimed to investigate the association between HGI and carotid plaques in non-dialysis CKD stage 3-5 patients.

Methods: This retrospective cross-sectional study included 195 non-dialysis CKD stage 3-5 patients. HGI was calculated as the difference between observed glycated hemoglobin (HbA1c) and predicted HbA1c, which was derived from fasting blood glucose. Carotid plaques were assessed via ultrasound. Multivariable logistic regression models were used to examine the association between HGI and carotid plaques, adjusting for cardiovascular risk factors (age, sex, body mass index, smoking, drinking, hypertension, cholesterol), CKD-related variables (estimated glomerular filtration rate, hemoglobin, intact parathyroid hormone) and medications (statins, sodium-glucose cotransporter-2 inhibitor, and glucagon-like peptide-1 receptor agonist). Restricted cubic spline (RCS) analysis was conducted to explore nonlinear relationships, and a threshold effect analysis was performed using piecewise logistic regression. Subgroup analyses were conducted to examine consistency across different subgroups. Causal mediation analysis was used to assess the potential mediating roles of age and diabetes mellitus.

Results: Among 195 non-dialysis CKD stage 3-5 patients, higher HGI was independently associated with carotid plaque (OR 1.76, 95% CI 1.09-2.98, P = 0.026). RCS analysis revealed a nonlinear relationship with a threshold at HGI = 0.2. Above this value, the risk of plaque increased significantly. ROC analysis showed modest discrimination (AUC = 0.64). Subgroup analysis confirmed the association in diabetic patients but not in non-diabetics. Mediation analysis indicated that age and diabetes explained 37.3% and 46.9% of the HGI-plaque association, respectively.

Conclusions: In non-dialysis CKD stage 3-5 patients, higher HGI was independently associated with the presence of carotid plaque, particularly among those with diabetes. These findings suggest that HGI may serve as a useful marker for vascular risk stratification in this high-risk population. However, its predictive value appeared limited in non-diabetic patients, indicating that the interpretation of HGI in this subgroup should be made with caution and warrants further investigation.