Fasting Glucose Levels in Predicting 1-Year All-Cause Mortality in Patients Who Do Not Have Diabetes and Are on Maintenance Hemodialysis

Abstract

Chronic inflammation and malnutrition relate to increased risks for cardiovascular death. This study compared fasting glucose levels (FGL) and impaired fasting glucose (IFG) with malnutrition and inflammation in nondiabetic maintenance hemodialysis (MHD) patients to investigate the adverse affects and risks for mortality. In total, 693 MHD patients were enrolled in this study and followed up for 1 yr. Geographic, hematologic, biochemical, and dialysis-related data were collected. According to 1997 and 2003 definitions, all patients were classified into three groups: Diabetic, nondiabetic with IFG, and nondiabetic with normal FGL. More diabetic and nondiabetic with IFG group patients were malnourished ( 2 ϭ 24.55, P Ͻ 0.0001) and had inflammatory changes ( 2 ϭ 9.32, P ϭ 0.0095) than those with normal FGL. The IFG group had higher high-sensitivity C-reactive protein and ferritin and lower serum albumin, creatinine levels, and normalized protein catabolic rate than the normal FGL group. Age and parameters of nutrition and inflammation were associated with FGL. Stepwise multiple regression analysis demonstrated that FGL were negatively associated with serum albumin (P ϭ 0.0026) and positively correlated with Log high-sensitivity C-reactive protein (P ϭ 0.0004) in nondiabetic MHD patients. In addition, after 1 yr of follow-up, Cox multivariate analysis demonstrated that, after adjustment for other significant related factors, FGL (relative risk 1.049; 95% confidence interval 1.007 to 1.093; P ϭ 0.0232) or presence of IFG (relative risk 3.798; 95% confidence interval 1.168 to 12.344; P ϭ 0.0265) was a significant risk factor for 1-yr all-cause mortality of these patients. On the basis of these findings, basal FGL or presence of IFG, a preventive and treatable status, plays an important role in inflammation, malnutrition, and short-term mortality of nondiabetic MHD patients. 18: 238518: -239118: , 200718: . doi: 10.1681 Fasting glucose levels (FGL) are important for diagnosis of diabetes and impaired fasting glucose (IFG). 1 Diabetes is associated with increased incidence of cardiovascular disease (CVD) in both men and women in most racial and ethnic groups. 1,2 Individuals with IFG have increased risk for future diabetes and may also have increased risk for CVD. [3][4][5] Because IFG is associated with increased CVD risk, initiating preventive interventions is important for these patients. However, the clinical significance of FGL and IFG in maintenance hemodialysis (MHD) patients remains unclear. J Am Soc NephrolAccording to the US Renal Data System, the annual mortality rate for MHD patients is 25%, with nearly 50% of all reported MHD patient deaths being attributed to cardiovascular complications. 6 Although traditional risk factors for CVD are common in patients with ESRD, these factors alone may not explain the high prevalence of CVD. 7 Clinical

Older Age, Higher Body Mass Index and Inflammation Increase the Risk for New-Onset Diabetes and Impaired Glucose Tolerance in Patients on Peritoneal Dialysis?

“…Since new-onset diabetes and IGT (NODI) is a common complication among patients on dialysis (4)(5)(6)8), it is important to explore the potential risk factors for this complication. However, published data on this issue are limited in dialysis populations.…”

The Frequency of Prediabetes and Contributing Factors in Patients with Chronic Kidney Disease

“…Hyperinsulinemia, glucose intolerance, and dyslipidemia characterizing prediabetes can be found in non-diabetic patients with kidney disease even before the advanced stages of renal function impairment [10,11].…”

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“…26 Prediabetes in hemodialysis patients, besides increasing risk of PTDM, also correlates with higher mortality while on dialysis, due to its association with proinflammatory markers and poor nutritional status. 27 It remains to be seen whether achieving euglycemia in patients on kidney transplant wait lists improves survival. Patients with HBV and HCV infections and prediabetes may be considered for the treatment of these infections to ameliorate this risk.…”