Immunonutritional Vulnerability Across HbA1c Categories in Diabetic Kidney Disease: A Cross-Sectional Study

Abstract

Diabetic kidney disease (DKD) is frequently accompanied by nutritional and inflammatory abnormalities that may not be reflected by glycated hemoglobin (HbA1c) alone. We evaluated immunonutritional status according to HbA1c category and examined whether HbA1c was independently associated with the Prognostic Nutritional Index (PNI) in adults with DKD. This cross-sectional study included 50 patients with type 2 diabetes and DKD. PNI was calculated from serum albumin and total lymphocyte count. HbA1c was analyzed continuously and as <7% versus ≥7%. Group comparisons used the Mann–Whitney U test, independent-samples t-test, or Fisher’s exact test as appropriate. Multivariable linear regression assessed the association between HbA1c and PNI after adjustment for eGFR, age, sex, and diabetes duration. Overall, 82.0% of participants had HbA1c <7%, 80.0% had PNI ≤50, 50.0% had PNI ≤40, and 60.0% had hypoalbuminemia; 76.0% had G4–G5 CKD. Among participants with HbA1c <7%, 82.9% had PNI ≤50 and 65.9% had hypoalbuminemia. PNI did not differ significantly between HbA1c groups (39.61 [34.45–48.16] vs 46.34 [36.36–51.36]; p=0.383), nor did serum albumin (3.33±0.72 vs 3.52±0.62 g/dL; p=0.462). HbA1c was not independently associated with PNI (B=−0.298, 95% CI −2.027 to 1.431; p=0.730). Immunonutritional vulnerability was common in this predominantly advanced-DKD cohort, including among patients with HbA1c <7%, supporting nutritional assessment alongside glycemic monitoring.