Poor pre-dialysis glycaemic control is a predictor of mortality in type II diabetic patients on maintenance haemodialysis

Wu, Mai Szu; Yu, Cao; Yang, Chih Wei; Wu, Ching Herng; Haung, Jeng Yi; Hong, Jiang; Chiang, Cindy; Huang, Chien Chang; Leu, Ming-Sheng

doi:10.1093/ndt/12.10.2105

Cited by 132 publications

(103 citation statements)

References 3 publications

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“…However, a recent cohort study of type 2 diabetes indicated diminished cardiovascular benefit from intensive blood glucose control in patients with high levels of comorbidity (24). Until the past few years, there had been few studies that examined the association between HgbA1c and clinical outcomes in the diabetic dialysis population (25)(26)(27), most of them small observational studies performed outside of the United States. Limited data from older studies appeared to suggest that poor glycemic control in patients with diabetes on dialysis was associated with increased morbidity (28,29).…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Williams

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: The benefits and risks of aggressive glycemic control in diabetes mellitus complicated by end-stage kidney failure remain uncertain but have importance because of the large patient population with inferior overall prognosis. Recent large observational studies with differing methodologies reached somewhat contrasting conclusions regarding the association of hemoglobin A1c with survival in diabetic chronic hemodialysis patients.Design, setting, participants, & measurements: This study supplements the authors' previous analysis (which found no correlation) by extending the follow-up period to 3 years and using time-dependent survival models with repeated measures. Among 24,875 nationally distributed study patients, 94.5% had type 2 diabetes, allowing additional analysis in the subset with type 1 diabetes. Data were collected at baseline and every quarter to a maximum of 3 years' follow-up.Results: Adjusted standard and time-dependent Cox models indicated that only extremes of glycemia were associated with inferior survival. There was no effect modification by serum albumin levels, a marker of protein nutrition status, and no trend associated with random glucose measurements in a post hoc analysis. In type 1 diabetic patients, upper extreme hemoglobin A1c values indicated lower survival risk.Conclusions: Sustained extremes of glycemia were only variably and weakly associated with decreased survival in this population. In the absence of randomized, controlled trials, these results suggest that aggressive glycemic control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk. Physicians are encouraged to individualize glycemic targets based on potential risks and benefits in diabetic ESRD patients.

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Section: Discussionmentioning

confidence: 99%

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Williams

Lacson²,

Wang³

et al. 2010

Clinical Journal of the American Society of Nephrology

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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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“…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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Poor pre-dialysis glycaemic control is a predictor of mortality in type II diabetic patients on maintenance haemodialysis

Cited by 132 publications

References 3 publications

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

Glycemic Control and Extended Hemodialysis Survival in Patients with Diabetes Mellitus

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

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

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