Management of the Diabetic End-Stage Renal Disease (ESRD) Patient: Dialysis and Transplantation

Tuohy, Kathryn A.; Williams, Mark E.

doi:10.1016/b978-1-4160-0158-4.50014-8

Cited by 2 publications

(2 citation statements)

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“…Several factors impacting on ESRD glycemic management are known to exist, including pharmacodynamic effects of uremia and/or the dialysis procedure on insulin and carbohydrate metabolism, pharmacokinetic influences on insulin and oral hypoglycemic agents used to treat hyperglycemia, and potential effects on HbgA1c, used as the basis of glycemic management. 40 Glycohemoglobin measurements in this report utilized an immunoturbidimetric assay performed in a single laboratory. Unlike high-pressure liquid chromatography commonly used in routine laboratory determinations of HgbA1c, the immunoturbidimetric assay is not influenced by high urea levels or hemoglobin variants.…”

Section: Discussionmentioning

confidence: 99%

“…Issues related to poor glycemic control in the ESRD patient with DM would be expected to include acute management problems such as fluid overload, hyperkalemia, and ketoacidosis, and certain chronic manifestations such as refractory gastroparesis and malnutrition. 40,44,45 Chronic hyperglycemia has been increasingly hypothesized to contribute to coronary heart disease, the major source of morbidity and mortality, in individuals with diabetes. 13 The United Kingdom Prospective Diabetes Study of patients with type II diabetes showed a 16% reduction (P ¼ 0.052) in myocardial infarction with intensive glycemic control after 10 years of follow-up, although the overall results for cardiovascular outcomes were considered negative.…”

Section: Discussionmentioning

confidence: 99%

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Hemodialyzed type I and type II diabetic patients in the US: Characteristics, glycemic control, and survival

Williams

Lacson

Teng

et al. 2006

Kidney International

170

148

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Diabetes mellitus (DM) constitutes a major end-stage renal disease (ESRD) health problem. Glycemic control is fundamental to the management of diabetes and its complications, and relies on monitoring of hyperglycemia. We therefore performed a primary data analysis of glycemic control and survival on a large national ESRD database. Ninety-five percent of patients with DM had type II diabetes (N = 23,504), and five percent had type I diabetes (N = 1,371). For the combined population, the mean hemoglobin A1c (HgbA1c) was 6.77%, and the mean random blood glucose was 168 mg/dl. Mean HgbA1c values were >7.0% in 35% and >8.5% in 14%. Mean HgbA1c values were below 5% in 11.3% of patients. Type I study patients tended to have higher HgbA1c values. Most patients (75.8%) had three or more random blood glucose determinations within 90 days preceding the HgbA1c measurement. The HgbA1c showed only a weak correlation with mean random glucose values (R2 0.3716; s.e. = 1.36). The survival rates in the subsequent 12-month period ranged from 80 to 85% across different HgbA1c strata. Kaplan-Meier survival curves grouped by HgbA1c levels showed no correlation between HgbA1c and survival at 12 months. More studies are needed to refine recommendations for the role of HgbA1c and glycemic control in this patient population.

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Section: Discussionmentioning

confidence: 99%