Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

Morioka, Tomoaki; Emoto, Masanori; Tabata, Tsutomu; Shoji, Tetsuo; Tahara, Hideki; Kishimoto, Hiroshi; Ishimura, Eiji; Nishizawà, Yoshiki

doi:10.2337/diacare.24.5.909

Cited by 210 publications

(148 citation statements)

References 27 publications

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“…This result suggests that HbA 1c ratios less than 7.3% are an adequate goal for glycaemic control in patients with diabetes on haemodialysis. This finding is consistent with the results of a previous report [12].…”

Section: Discussionsupporting

confidence: 94%

“…Morioka et al evaluated the clinical significance of glycaemic control in diabetic ESRD patients on haemodialysis, and revealed that, among patients with diabetes, those with poor glycaemic control (HbA 1c ≥7.5%) had a higher mortality risk than those with good control (HbA 1c < 7.5%) [12]. To date, however, two issues on glycaemic control and mortality have not been resolved, namely whether patients with diabetes and good glycaemic control have a higher mortality risk than those without diabetes, and whether there is any threshold of glycaemic control associated with a higher mortality risk among diabetes patients on haemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Among haemodialysis patients, those with diabetes have higher mortality than those without it [11]; and among patients with diabetes on haemodialysis, HbA 1c >7.5% is associated with higher mortality risk [12]. Although these studies have suggested an association between diabetes and mortality, it remains unclear whether patients with diabetes and 'good' glycaemic control have higher mortality risk than those without diabetes, or whether the relationship between higher HbA 1c level and risk is linear or subject to a threshold effect.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

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Aims/hypothesis There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis. Subjects and methods Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan. The diagnosis of diabetes at baseline and information on clinical events during follow-up were abstracted from the medical records. A Cox proportional hazards model was used to evaluate the association between presence or absence of diabetes, glycaemic control (HbA 1c quintiles) and mortality risk. Results Data from 1,569 patients with and 3,342 patients without diabetes on haemodialysis were analysed. Among patients on haemodialysis, those with diabetes had a higher mortality risk than those without (multivariable hazard ratio 1.37, 95% CI 1.08-1.74). Compared with those in the bottom quintile of HbA 1c level, the multivariable-adjusted hazard ratio for mortality was not increased in the bottom second to fourth quintiles of HbA 1c (HbA 1c 5.0-5.5% to 6.2-7.2%), but was significantly increased to 2.36 (95% CI 1.02-5.47) in the fifth quintile (HbA 1c ≥7.3%). The effect of poor glycaemic control did not statistically correlate with baseline mortality risk (p=0.27). Conclusions/interpretation Among dialysis patients, poorer glycaemic control in those with diabetes was associated with higher mortality risk. This suggests a strong effect of poor glycaemic control above an HbA 1c level of about 7.3% on mortality risk, and that this effect does not appear to be influenced by baseline comorbidity status.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

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“…Although these trials excluded patients on hemodialysis, it has been argued that better glycemic control is key toward preventing DM‐related complications in this population 3, 7, 8, 9. In fact, surprisingly few studies have investigated the association between HbA 1c and clinical outcomes in the dialysis population 3, 10, 11, 12, 13, 14, 15, 16. Most of these studies focused only on all‐cause mortality as the outcome and were limited by small sample size and correspondingly low statistical power 11, 12, 13, 15…”

Section: Introductionmentioning

confidence: 99%

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Montez‐Rath

et al. 2017

JAHA

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BackgroundThere is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus.Methods and ResultsWe included adult Medicare‐insured patients with diabetes mellitus who initiated in‐center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time‐averaged glycated hemoglobin (HbA1c) values were categorized into <48 mmol/mol (<6.5%) (reference), 48 to <58 mmol/mol (6.5% to <7.5%), 58 to <69 mmol/mol (7.5% to <8.5%), and ≥69 mmol/mol (≥8.5%). Medicare claims were used to identify outcomes of cardiovascular mortality, nonfatal myocardial infarction (MI), fatal or nonfatal MI, stroke, and peripheral arterial disease. We used Cox models as a function of time‐varying exposure to estimate multivariable adjusted hazard ratios and 95%CI for the associations between HbA1c and time to study outcomes in a cohort of 16 387 eligible patients. Patients with HbA1c 58 to <69 mmol/mol (7.5% to <8.5%) and ≥69 mmol/mol (≥8.5%) had 16% (CI, 2%, 32%) and 18% (CI, 1%, 37%) higher rates of cardiovascular mortality (P‐trend=0.01) and 16% (CI, 1%, 33%) and 15% (CI, 1%, 32%) higher rates of nonfatal MI (P‐trend=0.05), respectively, compared with those in the reference group. Patients with HbA1c ≥69 mmol/mol (≥8.5%) had a 20% (CI, 2%, 41%) higher rate of fatal or nonfatal MI (P‐trend=0.02), compared with those in the reference group. HbA1c was not associated with stroke, peripheral arterial disease, or all‐cause mortality.ConclusionsHigher HbA1c levels were significantly associated with higher rates of cardiovascular mortality and MI but not with stroke, peripheral arterial disease, or all‐cause mortality in this large cohort of hemodialysis patients with diabetes mellitus.

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“…Only a few studies have shown beneficial impact of predialysis glycemic control on survival after initiation of dialysis (6,7). In addition, limited studies showed an association of poor glycemic control with poor survival on chronic dialysis (8,9).…”

Section: In Diabetic Patients Glycemic Control Has An Essential Rolementioning

confidence: 99%

Association between Markers of Glycemic Control, Cardiovascular Complications and Survival in Type 2 Diabetic Patients with End-Stage Renal Disease

et al. 2007

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Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

Cited by 210 publications

References 27 publications

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Association between Markers of Glycemic Control, Cardiovascular Complications and Survival in Type 2 Diabetic Patients with End-Stage Renal Disease

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