Skip to main content

Advertisement

SpringerLink
Log in

High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Poor glycemic control associates with increased mortality in diabetic (DM) dialysis patients, but it is less well established whether high blood glucose (BG) independent of pre-existing diabetic status associates with mortality in dialysis patients. We assessed factors affecting BG at the start of peritoneal dialysis (PD) and its mortality-predictive impact in Korean PD patients.

Methods

In 174 PD patients (55 % males, 56 % DM), BG, nutritional status, comorbidity (CMD), and residual renal function (RRF) were assessed in conjunction with dialysis initiation. Determinants of BG and its association with mortality after a mean follow-up period of 30 ± 24 months were analyzed.

Results

On Cox proportional hazards analysis comprising all patients, old age, high CMD score, presence of protein energy wasting, and low serum albumin (Salb) concentration were independent predictors of mortality but not a high-BG level, while in patients without pre-existing diabetic status, high BG, together with old age and high CMD score, was an independent predictor of mortality. After adjustment for age, CMD score, and Salb, the risk ratio for mortality increased by 12 % per 1 mg/dL increase in BG in the non-DM patients. Patient survival in patients without pre-existing diabetic status with high BG did not differ from DM patients, but the survival of patients with high BG was significantly lower than in patients with low BG. In patients without pre-existing diabetic status, in multiple regression analysis, high BG at initiation of PD associated with high age, high body mass index, and low RRF.

Conclusions

High blood glucose at initiation of PD associated with an increased mortality risk in PD patients without pre-existing diabetic status suggesting that blood glucose monitoring and surveillance of factors contributing to poor glycemic control are warranted in patients initiating PD therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Xu H, Huang X, Arnlov J et al (2014) Clinical correlates of insulin sensitivity and its association with mortality among men with CKD stages 3 and 4. Clin J Am Soc Nephrol 9(4):690–697

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Jia T, Huang X, Qureshi AR et al (2014) Validation of insulin sensitivity surrogate indices and prediction of clinical outcomes in individuals with and without impaired renal function. Kidney Int 86(2):383–391

    Article  CAS  PubMed  Google Scholar 

  3. Shurraw S, Hemmelgarn B, Lin M et al (2011) Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study. Arch Intern Med 171(21):1920–1927

    Article  PubMed  Google Scholar 

  4. 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(6):1170–1177

    Article  CAS  PubMed  Google Scholar 

  5. Drechsler C, Krane V, Ritz E, Marz W, Wanner C (2009) Glycemic control and cardiovascular events in diabetic hemodialysis patients. Circulation 120(24):2421–2428

    Article  CAS  PubMed  Google Scholar 

  6. Kalantar-Zadeh K, Kopple JD, Regidor DL et al (2007) A1C and survival in maintenance hemodialysis patients. Diabetes Care 30(5):1049–1055

    Article  PubMed  Google Scholar 

  7. 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(5):1041–1048

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Yoo DE, Park JT, Oh HJ et al (2012) Good glycemic control is associated with better survival in diabetic patients on peritoneal dialysis: a prospective observational study. PLoS One 7(1):e30072

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Sekercioglu N, Dimitriadis C, Pipili C et al (2012) Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus. Int Urol Nephrol 44(6):1861–1869

    Article  CAS  PubMed  Google Scholar 

  10. Lin-Tan DT, Lin JL, Wang LH et al (2007) Fasting glucose levels in predicting 1-year all-cause mortality in patients who do not have diabetes and are on maintenance hemodialysis. J Am Soc Nephrol 18(8):2385–2391

    Article  CAS  PubMed  Google Scholar 

  11. Shurraw S, Majumdar SR, Thadhani R, Wiebe N, Tonelli M (2010) Glycemic control and the risk of death in 1484 patients receiving maintenance hemodialysis. Am J Kidney Dis 55(5):875–884

    Article  PubMed  Google Scholar 

  12. Fortes PC, de Moraes TP, Mendes JG et al (2009) Insulin resistance and glucose homeostasis in peritoneal dialysis. Perit Dial Int 29(Suppl 2):S145–S148

    CAS  PubMed  Google Scholar 

  13. Szeto CC, Chow KM, Kwan BC et al (2007) New-onset hyperglycemia in nondiabetic Chinese patients started on peritoneal dialysis. Am J Kidney Dis 49(4):524–532

    Article  CAS  PubMed  Google Scholar 

  14. CANADA-USA (CANUSA) Peritoneal Dialysis Study Group (1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcome. J Am Soc Nephrol 7:198–207

    Google Scholar 

  15. Bergström J, Heimbürger O, Lindholm B (1998) Calculation of the protein equivalent of total nitrogen appearance from urea appearance. Which formulas should be used? Perit Dial Int 18(5):467–473

    PubMed  Google Scholar 

  16. Watson PE, Watson ID, Batt RD (1980) Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 33:27–39

    CAS  PubMed  Google Scholar 

  17. Heimbürger O (1996) Residual renal function, peritoneal transport characteristics and dialysis adequacy in peritoneal dialysis. Kidney Int 56(Suppl):S47–S55

    Google Scholar 

  18. Davies SJ, Phillips L, Naish PF, Russell GI (2002) Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival. Nephrol Dial Transplant 17(6):1085–1092

    Article  PubMed  Google Scholar 

  19. Galach M, Waniewski J, Axelsson J et al (2011) Mathematical modeling of the glucose-insulin system during peritoneal dialysis with glucose-based fluids. ASAIO J 57(1):41–47

    Article  CAS  PubMed  Google Scholar 

  20. Kim SG, Lim HS, Cheong HK, Kim CS, Seo HJ (2007) Incidence and risk factors of insulin resistance syndrome in 20–59 year-old Korean male workers. J Korean Med Sci 22(6):968–972

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Findeisen HM, Pearson KJ, Gizard F et al (2011) Oxidative stress accumulates in adipose tissue during aging and inhibits adipogenesis. PLoS One 6(4):e18532

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Finkel T, Holbrook NJ (2000) Oxidants, oxidative stress and the biology of ageing. Nature 408(6809):239–247

    Article  CAS  PubMed  Google Scholar 

  23. Pashkow FJ (2011) Oxidative stress and inflammation in heart disease: Do antioxidants have a role in treatment and/or prevention? Int J Inflam 2011:514623

    Article  PubMed Central  PubMed  Google Scholar 

  24. Escriva F, Gavete ML, Fermin Y et al (2007) Effect of age and moderate food restriction on insulin sensitivity in Wistar rats: role of adiposity. J Endocrinol 194(1):131–141

    Article  CAS  PubMed  Google Scholar 

  25. Arita Y, Kihara S, Ouchi N et al (1999) Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 257(1):79–83

    Article  CAS  PubMed  Google Scholar 

  26. Wang B, Jenkins JR, Trayhurn P (2005) Expression and secretion of inflammation-related adipokines by human adipocytes differentiated in culture: integrated response to TNF-alpha. Am J Physiol Endocrinol Metab 288(4):E731–E740

    Article  CAS  PubMed  Google Scholar 

  27. Tsigos C, Kyrou I, Chala E et al (1999) Circulating tumor necrosis factor alpha concentrations are higher in abdominal versus peripheral obesity. Metabolism 48(10):1332–1335

    Article  CAS  PubMed  Google Scholar 

  28. Trirogoff ML, Shintani A, Himmelfarb J, Ikizler TA (2007) Body mass index and fat mass are the primary correlates of insulin resistance in nondiabetic stage 3–4 chronic kidney disease patients. Am J Clin Nutr 86(6):1642–1648

    CAS  PubMed  Google Scholar 

  29. Chen J, Muntner P, Hamm LL et al (2003) Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. J Am Soc Nephrol 14(2):469–477

    Article  CAS  PubMed  Google Scholar 

  30. Landau M, Kurella-Tamura M, Shlipak MG et al (2011) Correlates of insulin resistance in older individuals with and without kidney disease. Nephrol Dial Transplant 26(9):2814–2819

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Kovesdy CP, Park JC, Kalantar-Zadeh K (2010) Glycemic control and burnt-out diabetes in ESRD. Semin Dial 23(2):148–156

    Article  PubMed  Google Scholar 

  32. Chen KH, Lin JL, Hung CC et al (2011) Impaired fasting glucose association with mortality in nondiabetic patients on maintenance peritoneal dialysis. Am J Med Sci 341(4):312–317

    Article  PubMed  Google Scholar 

  33. Banerjee D, Recio-Mayoral A, Chitalia N, Kaski JC (2011) Insulin resistance, inflammation, and vascular disease in nondiabetic predialysis chronic kidney disease patients. Clin Cardiol 34(6):360–365

    Article  PubMed  Google Scholar 

  34. Yilmaz MI, Stenvinkel P, Sonmez A et al (2011) Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes. Nephrol Dial Transplant 26(11):3537–3543

    Article  PubMed  Google Scholar 

  35. Shinohara K, Shoji T, Emoto M et al (2002) Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 13(7):1894–1900

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Bengt Lindholm is employed by Baxter Healthcare Corporation.

Author information

Authors and Affiliations

  1. Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden

    Sung Hee Chung & Bengt Lindholm

  2. Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea

    Dong Cheol Han, Hyunjin Noh, Jin Seok Jeon, Soon Hyo Kwon & Hi Bahl Lee

  3. Kim’s Clinic and Dialysis Unit, Miryang, Korea

    Hi Bahl Lee

Authors
  1. Sung Hee Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong Cheol Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyunjin Noh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Seok Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soon Hyo Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bengt Lindholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hi Bahl Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bengt Lindholm.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chung, S.H., Han, D.C., Noh, H. et al. High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy. Int Urol Nephrol 47, 1017–1024 (2015). https://doi.org/10.1007/s11255-015-0987-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-015-0987-z

Keywords

Search

Navigation