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HbA1c and survival in maintenance hemodialysis patients with diabetes in Han Chinese population

  • Nephrology - Original Paper
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Abstract

Background

Previous observational studies using differing methodologies have yielded inconsistent results regarding the association between glycemic control and outcomes in diabetic patients receiving maintenance hemodialysis (MHD). The aim of this study was to investigate the association between HbA1c and survival in diabetic MHD patients in Han Chinese population.

Methods

A 5-year cohort (October 2007–December 2013) of 236 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality. Death hazard ratios (HR) were estimated using Cox regressions.

Results

Two hundred and thirty-six diabetes patients undergoing MHD in clinics over 5 years were included in our study. Unadjusted survival analyses indicated paradoxically lower death HRs with higher HbA1c values. However, after adjusting for potential confounders (demographics, dialysis vintage, comorbidity, anemia, and inflammation), higher HbA1c values were incrementally associated with higher death risks.

Conclusions

Poor glycemic control (HbA1c ≥ 8 %) appears to be associated with decreased survival in the general population of diabetic MHD patients. Our study suggests that moderate hyperglycemia increases the risk for all-cause mortality of diabetic MHD patients in Han Chinese population.

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References

  1. Foley RN, Collins AJ (2007) End-stage renal disease in the United States: an update from the United States renal data system. J Am Soc Nephrol 18:2644–2648

    Article  PubMed  Google Scholar 

  2. Liu ZH (2013) Nephrology in China. Nat Rev Nephrol 9:523–528

    Article  PubMed  Google Scholar 

  3. Warram JH, Manson JE, Krolewski AS (1995) Glycosylated hemoglobin and the risk of retinopathy in insulin-dependent diabetes mellitus. N Engl J Med 332:1305–1306

    Article  PubMed  CAS  Google Scholar 

  4. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl JMed 329:977–986

    Article  Google Scholar 

  5. Morioka T, Emoto M, Tabata T et al (2001) Glycemic control is a predictor of survival for diabetic patients on hemodialysis. Diabetes Care 24:909–913

    Article  PubMed  CAS  Google Scholar 

  6. Oomichi T, Emoto M, Tabata T et al (2006) Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study. Diabetes Care 29:1496–1500

    Article  PubMed  Google Scholar 

  7. Hayashino Y, Fukuhara S, Akiba T et al (2007) Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan dialysis outcomes and practice pattern study. Diabetologia 50:1170–1177

    Article  PubMed  CAS  Google Scholar 

  8. Ishimura E, Okuno S, Kono K et al (2009) Glycemic control and survival of diabetic hemodialysis patients-importance of lower hemoglobin A1C levels. Diabetes Res Clin Pract 83:320–326

    Article  PubMed  CAS  Google Scholar 

  9. American Diabetes Association (2010) Standards of medical care in diabetes—2010. Diabetes Care 33:S11–S61

    Article  PubMed Central  Google Scholar 

  10. K/DOQI Workgroup (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45:S46–S48

    Article  Google Scholar 

  11. KDOQI (2007) Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 49:S12–S154

    Article  Google Scholar 

  12. Gerstein HC, Miller ME, Byington RP et al (2008) Action to control cardiovascular risk in diabetes study group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559

    Article  PubMed  CAS  Google Scholar 

  13. Patel A, MacMahon S, Chalmers J et al (2008) ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572

    Article  PubMed  CAS  Google Scholar 

  14. Ix JH (2010) Hemoglobin A1C in hemodialysis patients: should one size fit all? Clin J Am Soc Nephrol 5:1539–1541

    Article  PubMed  Google Scholar 

  15. Williams ME, Lacson E Jr, Wang W et al (2010) Glycemic control and extended hemodialysis survival in patients with diabetes mellitus: comparative results of traditional and time-dependent Cox model analyses. Clin J Am Soc Nephrol 5:1595–1601

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shurraw S, Majumdar SR, Thadhani R et al (2010) Alberta kidney disease network. Glycemic control and the risk of death in 1,484 patients receiving maintenance hemodialysis. Am J Kidney Dis 55:875–884

    Article  PubMed  Google Scholar 

  17. Kalantar-Zadeh K, Kopple JD, Regidor DL et al (2007) A1C and survival in maintenance hemodialysis patients. Diabetes Care 30:1049–1055

    Article  PubMed  Google Scholar 

  18. Gross JL, de Azevedo MJ, Silveiro SP et al (2005) Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 28:164–176

    Article  PubMed  Google Scholar 

  19. Rattanasompattikul M, Feroze U, Molnar MZ et al (2012) Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol 44(6):1813–1823

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kalantar-Zadeh K, Dunne E, Nixon K et al (1999) Near infra-red interactance for nutritional assessment of dialysis patients. Nephrol Dial Transplant 14:169–175

    Article  PubMed  CAS  Google Scholar 

  21. Ricks J, Molnar MZ, Kovesdy CP et al (2012) Glycemic control and cardiovascular mortality in hemodialysis patients with diabetes: a 6-year cohort study. Diabetes 61(3):708–715

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Collins AJ, Foley RN, Chavers B et al (2012) United States Renal Data System 2011 Annual Data Report: atlas of chronic kidney disease and end-stage renal disease in the United States. Am J Kidney Dis 59(A7):e1–e420

    Google Scholar 

  23. Tanaka Y, Atsumi Y, Matsuoka K et al (1998) Role of glycemic control and blood pressure in the development and progression of nephropathy in elderly Japanese NIDDM patients. Diabetes Care 21:116–120

    Article  PubMed  CAS  Google Scholar 

  24. Gaede P, Vedel P, Larsen N et al (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl JMed 348:383–393

    Article  Google Scholar 

  25. Williams ME, Lacson E Jr, Teng M et al (2006) Hemodialyzed type I and type II diabetic patients in the US: characteristics, glycemic control, and survival. Kidney Int 70:1503–1509

    Article  PubMed  CAS  Google Scholar 

  26. Wu MS, Yu CC, Yang CW et al (1997) Poor pre-dialysis glycaemic control is a predictor of mortality in type II diabetic patients on maintenance haemodialysis. Nephrol Dial Transplant 12:2105–2110

    Article  PubMed  CAS  Google Scholar 

  27. Sturm G, Lamina C, Zitt E et al (2011) Association of HbA1c values with mortality and cardiovascular events in diabetic dialysis patients. The INVOR study and review of the literature. PLoS ONE 6:1–8

    Google Scholar 

  28. Kovesdy CP, Park JC, Kalantar-Zadeh K (2010) Glycemic control and burnt-out diabetes in ESRD. Semin Dial 23:148–156

    Article  PubMed  Google Scholar 

  29. Kalantar-Zadeh K, Derose SF, Nicholas S et al (2009) Burnt-out diabetes: impact of chronic kidney disease progression on the natural course of diabetes mellitus. J Ren Nutr 19:33–37

    Article  PubMed  PubMed Central  Google Scholar 

  30. Duong U, Mehrotra R, Molnar MZ et al (2011) Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus. Clin J Am Soc Nephrol 6:1041–1048

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  31. Schwedler SB, Metzger T, Schinzel R et al (2002) Advanced glycation end products and mortality in hemodialysis patients. Kidney Int 62:301–310

    Article  PubMed  CAS  Google Scholar 

  32. Rambod M, Bross R, Zitterkoph J et al (2009) Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 53:298–309

    Article  PubMed  Google Scholar 

  33. McMurray SD, Johnson G, Davis S et al (2002) Diabetes education and care management significantly improve patient outcomes in the dialysis unit. Am J Kidney Dis 40:566–575

    Article  PubMed  Google Scholar 

  34. Kilpatrick RD, McAllister CJ, Kovesdy CP et al (2007) Association between serum lipids and survival in hemodialysis patients and impact of race. J Am Soc Nephrol 18:293–303

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People’s Republic of China

    Xiurong Li, Xianlin Xu, Jinfeng Liu, Liying Miao, Jia Di & Xiaozhou He

  2. Center of Kidney Disease, 2nd Affiliated Hospital, Nanjing Medical University, 262 Zhongshan North Rd., Nanjing, 210003, Jiangsu Province, China

    Xiurong Li, Junwei Yang & Li Fang

Authors
  1. Xiurong Li
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  2. Xianlin Xu
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  3. Jinfeng Liu
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  4. Junwei Yang
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  5. Li Fang
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  6. Liying Miao
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  7. Jia Di
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  8. Xiaozhou He
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Correspondence to Xiaozhou He.

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Li, X., Xu, X., Liu, J. et al. HbA1c and survival in maintenance hemodialysis patients with diabetes in Han Chinese population. Int Urol Nephrol 46, 2207–2214 (2014). https://doi.org/10.1007/s11255-014-0764-4

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  • DOI: https://doi.org/10.1007/s11255-014-0764-4

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