Effect of anti-diabetic drugs in dialysis patients with diabetes: a nationwide retrospective cohort study

Abstract

Background Type 2 diabetes mellitus is common in patients undergoing dialysis. However, the association between anti-diabetic drug use and survival outcomes is rarely discussed. We aimed to investigate whether continued anti-diabetic medication use affects the survival of diabetic dialysis patients and whether different hypoglycemic drug use influences prognosis. Methods Using a nationwide database, we enrolled patients with incident end-stage renal disease under maintenance dialysis during 2011–2015 into the pre-existing diabetes dialysis (PDD), incident diabetes after dialysis (IDD), and non-diabetic dialysis (NDD) groups. The PDD group was further subclassified into patients who continued (PDD-M) and discontinued (PDD-NM) anti-diabetic drug use after dialysis. Results A total of 5249 dialysis patients were examined. The PDD-NM group displayed a significantly higher mortality rate than the IDD, PDD-M, and NDD groups (log-rank test P < 0.001). The PDD-M group had a significantly lower risk of death, regardless of insulin (P < 0.001) or oral hypoglycemic agent (OHA) (P < 0.001) use. Initial insulin administration or OHA had no statistically significant effect on overall mortality in the IDD group. But OHA use had better survival trends than insulin administration for the older (P = 0.02) and male subgroups (P = 0.05). Conclusions For dialysis patients with diabetes, continuous administration of anti-diabetic drugs after dialysis and choice of medication may affect outcomes.

Associations of Estradiol With Mortality and Health Outcomes in Patients Undergoing Hemodialysis: A Prospective Cohort Study

“…Missing data were present for the following covariates: BMI (1.6%), predialysis SBP (1.2%), and serum albumin (11.0%). Thus, missing data were estimated via multiple imputations using multivariable normal regression; the number of iterations (16) was greater than the maximum fraction (11%) of missingness. 30 In subgroup analyses, we assessed whether diabetes status (yes vs no) and age (above or below the median age of 63 years) modified the associations between E2 and assessed outcomes using interaction terms.…”

“…15 Patients with diabetes have higher mortality rates and worse health outcomes compared with those without diabetes. 16,17 Furthermore, mortality rates are higher in women with diabetes compared with their male counterparts. 7,17,18 However, uncertainty remains in regard to whether diabetes could alter associations among E2, mortality, and HRQOL in patients undergoing hemodialysis (HD).…”

Making sense of glucose sensors in end-stage kidney disease: A review

“…The role of tight glycemic control in improving clinical outcomes in ESKD remains controversial ( 23 , 24 ). Using different retrospective ESKD database analyses, Kalantar-Zadeh ( 9 ) and Williams ( 8 ) found that glycemia, when considered as a continuous variable, was associated with poorer survival only at extremes of HbA1c.…”

An Observational Retrospective Real-World Study to Evaluate the Effect of Teneligliptin on Parameters of Renal Function, Glycemic Control, and Safety in Indian T2DM Patients with Chronic Kidney Disease (TOP RENAL)

“…According to the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) 2022 executive summary, the choice of therapy for T2DM depends on the patient's cardiac, cerebrovascular, and renal status [6]. According to the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline, only a few of several oral hypoglycemic agents can be administered in CKD patients, including sulfonylurea (Glipizide and Gliclazide), Meglitinide (Repaglinide), Thiazolidinediones (TZD), and Dipeptidylpeptidase IV (DPP-4) inhibitors [7,8].…”