Best Practice for Diabetic Patients on Hemodialysis 2012

Nakao, Toshiyuki; Inaba, Masaaki; Abe, Masanori; Kaizu, Kazo; Shima, Kenji; Babazono, Tetsuya; Tomo, Tadashi; Hirakata, Hideki; Akizawa, Tadao

doi:10.1111/1744-9987.12299

Cited by 67 publications

(89 citation statements)

References 146 publications

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“…Previous studies have shown that glycated albumin (GA), whose levels are unaffected by the life-span of red blood cells, may be a better indicator of glycemic control in HD patients than HbA1c [9,10]. The Japanese Society for Dialysis Therapy recommends pre-dialysis glucose levels and GA levels as better indicators of glycemic control than HbA1c in diabetic HD patients [11]. However, these studies used only casual blood glucose levels as the gold standard for comparison with HbA1c and GA levels.…”

Section: Introductionmentioning

confidence: 99%

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

et al. 2016

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Background: Glycated albumin (GA) has been reported to be a better indicator of glycemic control than hemoglobin A1c (HbA1c) in diabetic hemodialysis (HD) patients. Methods: We performed a cross-sectional study to evaluate associations between daily glucose profiles based on blood glucose measurements at seven different times a day and their GA, HbA1c, and pre-dialysis glucose levels in 90 HD patients with (n = 46) and without (n = 44) diabetes. Results: The results of a univariate analysis showed that the GA, HbA1c, and pre-dialaysis glucose levels were significantly correlated with the daily glucose profiles. In a multivariate analysis, the GA levels were found to be independently correlated with maximum glucose levels (F = 9.448, P = 0.0028) and mean amplitude of glucose excursion (MAGE, F = 5.169, P = 0.0255), but no significant correlation was found between the HbA1c levels and daily glucose profiles. The pre-dialysis glucose levels were independently correlated with minimum glucose levels (F = 8.336, P = 0.0049). In a stratified analysis, the identical trend was seen in the diabetic HD patients, but an independent correlation was found only between HbA1c values and mean glucose levels in nondiabetic HD patients. Conclusions: GA levels may be a better indicator of glycemic control than HbA1c and pre-dialysis glucose levels, especially as a means of evaluating the glucose excursions in diabetic HD patients.

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Section: Introductionmentioning

confidence: 99%

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

et al. 2016

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“…However, the present study showed no significant relationship between free carnitine and GA. Because we recruited HD patients whose glucose metabolism was well controlled, most of their GA values were under the target value for glycemic control [23]. That may be the reason why we could not find the significant relationship between them.…”

Section: Discussionmentioning

confidence: 94%

Decreased level of serum carnitine might lead to arteriosclerosis progression via the accumulation of advanced glycation end products in maintenance hemodialysis patients

et al. 2017

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Background: Carnitine is reported to improve insulin resistance and reduce oxidative stress. Hyperglycemia and increased oxidative stress are well known to promote the production of advanced glycation end products (AGEs) that can lead to arteriosclerosis in patients with maintenance hemodialysis (HD). In the present study, we aimed to determine whether decreased level of serum carnitine accelerated arteriosclerosis and to clarify the relationships between carnitine, AGEs, and arteriosclerosis in HD patients. Methods: We recruited 116 patients (65 men and 51 women, 62 ± 13 years) undergoing HD three times a week. We measured pre-HD serum free carnitine prior to the first weekly session. AGE level was quantitatively evaluated by measuring skin autofluorescence (SAF) with AGE reader. Arteriosclerosis was evaluated by measuring carotid intima-media thickness (cIMT). Relationships between free carnitine, SAF, and cIMT were analyzed, and significant limiting factors for arteriosclerosis were identified using univariate and multivariate regression analyses. Results: Free carnitine ranged from 14.9 to 53.3 μmol/L (mean, 28.6 ± 8.1 μmol/L). Free carnitine was negatively correlated with SAF (r = − 0.223, P = 0.017) and cIMT (r = − 0.252, P = 0.006). SAF was positively correlated with cIMT (r = 0.263, P = 0.005). Free carnitine was identified as a significant independent limiting factor for cIMT (β = -0.194, P = 0.037). Conclusions: Decreased level of serum carnitine might lead to the progression of arteriosclerosis via the AGE accumulation in HD patients.

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“…Patients with type 2 diabetes mellitus and ESRD have limited therapeutic options to manage hyperglycemia [7,29]. Furthermore, few randomized controlled trials have compared antihyperglycemic agents in these patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…However, treatment options available for these patients are limited due to safety and tolerability issues [6]. Oral medications recommended in the Japanese guidelines include only alpha-glucosidase inhibitors, meglitinides, and dipeptidyl peptidase-4 (DPP-4) inhibitors [7]. These three drug types in combination and insulin preparation are used in treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Saxagliptin versus Mitiglinid in patients with type 2 diabetes and end-stage renal disease

Sakai

Sakai²,

Mugishima

et al. 2017

Ren Replace Ther

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Background: There are very few oral antidiabetic drugs recommended for patients on dialysis. Saxagliptin is known for its potent effect and long duration of action. In this study, we compared the efficacy of Saxagliptin with Mitiglinid for diabetes control and renal anemia in hemodialysis patients with type 2 diabetes mellitus. Methods: We performed a 6-month prospective, open-label, parallel group study of 41 patients with type 2 diabetes mellitus undergoing hemodialysis who took alpha-glucosidase inhibitors or meglitinides and did not use insulin. Saxagliptin and Mitiglinid were administered at 2.5 and 5 mg/day, respectively. The primary outcomes were changes in hemoglobin A1c (HbA1c) and glycated albumin (GA). Other efficacy assessments included changes in Hb, darbepoetin alpha (DA) dose, and erythropoietin responsiveness index (ERI). Results: No patient required an increase in Saxagliptin or Mitiglinid dose, and there were no cases of hypoglycemia with symptoms. HbA1c and GA values were not significantly different between both groups. For HbA1c, the gradient of the regression line of the Saxagliptin and Mitiglinid groups were Y = −7.144e-005*X + 6.023 and Y = −0. 02604*X + 6.292, respectively, and no significant difference was found (p = 0.3281). However, for GA, the regression line of the Saxagliptin group significantly decreased (Y = −0.5036*X + 19.34 and Y = −0.2346*X + 18.79, p = 0.0371). Both groups did not have a significant change in the DA dose through the observation period. However, the DA dose of the Saxagliptin group significantly decreased when we compared the regression lines (Y = −0.8304*X + 21. 06 and Y = 0.6286*X + 16.12, p = 0.0019) of both groups. Furthermore, ERI did not change significantly but showed a significant difference when regression lines were compared (Y = −0.2030*X + 6.654 and Y = 0.1116*X + 5.288, p = 0.0082).

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Best Practice for Diabetic Patients on Hemodialysis 2012

Cited by 67 publications

References 146 publications

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

Decreased level of serum carnitine might lead to arteriosclerosis progression via the accumulation of advanced glycation end products in maintenance hemodialysis patients

Efficacy of Saxagliptin versus Mitiglinid in patients with type 2 diabetes and end-stage renal disease

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