Stringent glycaemic control prolongs survival in diabetic patients with end‐stage renal disease on haemodialysis

Shima, Kenji; Komatsu, Machiko; Kawahara, Katsunobu; Minaguchi, Jun; Kawashima, Seiichiro

doi:10.1111/j.1440-1797.2010.01273.x

Cited by 34 publications

(20 citation statements)

References 29 publications

(35 reference statements)

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“…Several studies based on cross-sectional HbA1c levels suggest that higher HbA1c associates with higher all-cause or CV mortality in patients on dialysis[38,39,40,41,42,43,44]. Time-dependent analyses using repeated measures of HbA1c reveal discordant results, either no association with mortality [45], or correlation with lower survival at extremely high and low HbA1c [46,47] to a paradoxical lower risk for CV events among those with higher HbA1 adjusted for demographics, Hb, and nutritional and inflammatory markers [48].…”

Section: Discussionmentioning

confidence: 99%

Glycated Albumin, Not Hemoglobin A1c, Predicts Cardiovascular Hospitalization and Length of Stay in Diabetic Patients on Dialysis

Murea

Moran²,

Russell³

et al. 2012

Am J Nephrol

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Background: The utility of glycated hemoglobin (HbA1c) and glycated albumin (GA) in diabetic dialysis patients remains unknown. GA was previously associated with all-cause hospitalization and patient survival. Relationships between GA, HbA1c, and casual plasma glucose (PG) with cause-specific cardiovascular (CV) disease, infectious disease (ID), and vascular access- (VA) related hospitalization rates and length of stay (LOS) were assessed. Methods: 444 prevalent diabetic dialysis patients had monthly PG, quarterly GA, and all HbA1c values recorded for 2.33 years; hospitalizations within 17 and 30 days of testing were evaluated. Best-fit, time-dependent Cox models were constructed in unadjusted, case-mix-adjusted (age, sex, race, BMI, diabetes duration, dialysis vintage), and case-mix- plus lab-adjusted (hemoglobin, albumin, phosphorus) models. Results: Mean ± SD diabetes duration was 18.5 ± 10.8 years and dialysis vintage 2.9 ± 2.6 years. In fully adjusted models, CV hospitalization rates were associated with increasing GA (HR 1.32; 95% CI 1.11–1.57; p = 0.002 at 17 days; HR 1.21; p = 0.02 at 30 days) and PG (HR 1.10; 95% CI 1.02–1.17; p = 0.01 at 17 days; HR 1.07; p = 0.03 at 30 days), not HbA1c (HR 1.24; 95% CI 0.89–1.73; p = 0.21 at 17 days; HR 1.26; p = 0.10 at 30 days). LOS for CV admissions was positively associated with GA (HR 1.18; 95% CI 1.01–1.39; p = 0.03), not PG (HR 1.04; 95% CI 0.99–1.10; p = 0.15) or HbA1c (HR 1.03; 95% CI 0.92–1.15; p = 0.21). Admissions due to ID and VA complications (and LOS) did not correlate with these assays. Conclusions: Improved glycemic control based on GA and PG predicted CV-related hospitalizations; GA also predicted CV hospitalization LOS. HbA1c did not predict cause-specific hospitalizations in dialysis populations.

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Section: Discussionmentioning

confidence: 99%

Glycated Albumin, Not Hemoglobin A1c, Predicts Cardiovascular Hospitalization and Length of Stay in Diabetic Patients on Dialysis

Murea

Moran²,

Russell³

et al. 2012

Am J Nephrol

View full text Add to dashboard Cite

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“…DM is the most common cause of kidney failure [2,3], and glycemic control is necessary for the prevention of renal insufficiency. Moreover, glycemic control to improve hyper-or hypoglycemia is an important factor in the overall prognosis of patients with endstage renal disease receiving hemodialysis (HD) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

et al. 2016

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Background: Linagliptin, the only bile-excreted dipeptidyl peptidase-4 (DPP-4) inhibitor, is a therapeutic drug for patients with diabetes receiving hemodialysis, for whom inflammation is a prognosis-related factor, because of its potential anti-inflammatory effects. Although the anti-inflammatory effects of linagliptin in vivo are reported, no study has described these effects in vitro. DPP-4 degrades glucagon-like peptide-1 (GLP-1), which is known to have anti-inflammatory properties. Since GLP-1 is a gut hormone secreted by intestinal L cells, in vivo examination of the GLP-1-independent anti-inflammatory effects of DPP-4 inhibitors is difficult. We evaluated the mitogen-activated protein kinase (MAPK)-dependent, GLP-1-independent, anti-inflammatory effects of linagliptin in lipopolysaccharide (LPS)-stimulated human umbilical vein endothelial cells (HUVECs) which do not secrete GLP-1. Furthermore, to determine whether linagliptin has unique pharmacological actions compared with other DPP-4 inhibitors, we assessed the anti-inflammatory effects of sitagliptin (a DPP-4 inhibitor without xanthine-related skeletal system activity), caffeine (a phosphodiesterase inhibitor), loxoprofen, and diclofenac sodium. Methods: HUVECs were cultured for 24 h at densities of 1-2 × 10 5 cells/mL. We pretreated HUVECs with or without linagliptin (1, 5, 10, 50, and 100 nM), 150 nM sitagliptin, 50 nM caffeine, 17 μM loxoprofen, or 1.3 μM diclofenac sodium for 1 h prior to incubation with LPS. The concentration of LPS used (1 μg/mL) was sufficient to induce an inflammatory response in HUVECs. Five hours after incubation with LPS, culture media was evaluated for interleukin (IL)-6 expression. Intranuclear p65 (a subunit of nuclear factor kappa-B (NFκB)) levels were measured 5 h after treatment with LPS and 50 nM linagliptin, while phosphorylated p38 MAPK levels were measured in the cytosolic fractions obtained 30 min after treatment with LPS and 50 nM linagliptin.

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“…Glycemic control is an important factor in the overall prognosis of hemodialysis (HD) patients [1,2]. Although insulin injections are central to therapy, failure of eyesight from diabetic retinopathy and the dementia that may accompany aging can make multiple daily insulin injections impossible [3].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effects of Alogliptin Benzoate in Hemodialysis Patients with Diabetes: A 2-year Study

Nakamura

Inagaki²,

Shimizu

et al. 2013

Nephron Clin Pract

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Aim: To evaluate the long-term efficacy of monotherapy with the dipeptidase-4 inhibitor alogliptin benzoate in hemodialysis (HD) patients with type 2 diabetes. Methods: Sixteen diabetic HD patients with inadequate glycemic control (hemoglobin A_1c (HbA1c) level >6.5% and glycated albumin (GA) level >20%) on diet and exercise participated in the study. No patients were taking other oral antidiabetic drugs or receiving insulin therapy. Alogliptin 6.25 mg was administered to patients once daily. HbA1c, GA levels were obtained before and after 2 years of treatment. Body weight and active glucagon-like peptide-1, blood glucose, insulin, C-peptide immunoreactivity, glucagon, albumin, hemoglobin, and total cholesterol levels were also examined before and after treatment. Results: Both HbA1c and GA levels decreased after starting alogliptin administration. As compared to the pretreatment levels, HbA1c and GA levels significantly decreased at 3 and 18 months, respectively, after starting alogliptin administration. HbA1c and GA levels decreased from 7.1 ± 0.2 to 5.8 ± 1.6% and from 22.5 ± 0.7 to 19.6 ± 0.6%, respectively, 24 months after beginning treatment. Glucagon-like peptide-1 levels (8.9 ± 5.7 pmol/l before treatment) doubled after treatment. Body weight and blood glucose, insulin, C-peptide immunoreactivity, glucagon, albumin, hemoglobin, and total cholesterol levels did not change with treatment. Only one significant adverse effect, a drug-related rash, was seen in 1 patient. Conclusion: Long-term (2-year) effects of alogliptin benzoate monotherapy suggest its efficacy as a new treatment strategy in diabetic HD patients.

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Stringent glycaemic control prolongs survival in diabetic patients with end‐stage renal disease on haemodialysis

Abstract: Intensive management of diabetic control at a stringent mean on-study PPG < 10.0 mmol/L will improve the life expectancy in diabetic dialysis patients. However, no range of HbA1c values obtained in this study showed any clear difference in clinical outcomes.

Cited by 34 publications

References 29 publications

Glycated Albumin, Not Hemoglobin A1c, Predicts Cardiovascular Hospitalization and Length of Stay in Diabetic Patients on Dialysis

Glycated Albumin, Not Hemoglobin A1c, Predicts Cardiovascular Hospitalization and Length of Stay in Diabetic Patients on Dialysis

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

Long-Term Effects of Alogliptin Benzoate in Hemodialysis Patients with Diabetes: A 2-year Study

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