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

Rhee, Jinnie J.; Zheng, Yuanchao; Montez‐Rath, Maria E.; Chang, Tara I.; Winkelmayer, Wolfgang C.

doi:10.1161/jaha.117.005581

Cited by 14 publications

(10 citation statements)

References 38 publications

(82 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…HbA1c values in groups with a worse and better outcome in our study were similar to those described in a US cohort study involving 16 387 diabetic patients who started HD treatment from 2006 to 2008 and survived for > 90 days. In that study, higher HbA1c level (7.5–8.5% and >8.5%) was significantly ( P =0.01) associated with higher rates of cardiovascular mortality (16%, 95% CI 2–32% and 18%, 95% CI 1–37%, respectively) and nonfatal myocardial infarction (MI) (16%, 95% CI 1–33% and 15%, 95% CI 1–32%, respectively), but not with stroke, peripheral arterial disease, or all-cause mortality, compared with the reference group (HbA1c <6.5%) [ 21 ]. In a large 6-year US study, which included 54 757 patients on HD, HbA1c levels <6% and >8% were associated with increased mortality [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes

et al. 2021

View full text Add to dashboard Cite

Background Patients receiving dialysis who also have diabetes mellitus have high mortality. This study aimed to investigate the risk factors associated with all-cause death among Polish patients with diabetes receiving dialysis. Material/Methods This prospective observational study included 100 patients with type 1 or type 2 diabetes who were treated with peritoneal dialysis or hemodialysis. Blood laboratory tests, the occurrence of diabetes complications, and comorbidity, using the Charlson Comorbidity Index, were estimated. Survival analysis was performed using the multivariate Cox proportional hazard model, and Kaplan-Meyer survival analyses with log-rank tests were performed to show differences between groups. Results During 16.0±5.0 months, 23 patients died. The deceased group had significantly higher levels of HbA1c ( P =0.046) and fructosamine ( P =0.011) than the surviving group. The deceased patients also had higher comorbidity scores ( P =0.013). In the stepwise multivariate Cox proportional hazard regression model, history of stroke or transient ischemic attack was an independent risk factor of all-cause death (hazard ratio [HR] 3.15, 95% CI 1.34–7.39; P =0.009), while regular physical activity significantly reduced the risk of all-cause death (HR 0.26, 95% CI 0.08–0.87; P =0.029). Conclusions Deceased patients had higher HbA1c and fructosamine levels and higher comorbidity. However, history of stroke or transient ischemic attack was an independent risk factor of all-cause death, while regular physical activity was associated with the reduction of the risk of all-cause death in patients with type 1 and type 2 diabetes treated with peritoneal dialysis or hemodialysis. Regular physical activity should be recommended to improve survival in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Patients on hemodialysis may have falsely low HbA1c levels due to shorter erythrocyte lifespan, lower erythrocyte concentrations seen in anemia, or predominance of younger erythrocytes, which occur in patients who are on iron replacement therapy or erythropoiesis-stimulating agents. 10,36 Third, because we abstracted the data on comorbidities from an administrative database, we were not able to adjust for the severity of these conditions. However, the under-ascertainment of comorbidities would have led to nondifferential bias, biasing the results toward the null and underestimating the true effect.…”

Section: Discussionmentioning

confidence: 99%

“…Description on how reported comorbidities and socioeconomic data were obtained has been reported previously. 10 Briefly, comorbidities were obtained from claims using the International Classification of Diseases, Ninth Revision, diagnosis and procedure codes from at least 1 inpatient or 2 or more outpatient encounters separated by at least 1 day. We combined information from both the Medical Evidence Report and claims data to define baseline comorbidities and used claims thereafter to create quarterly-updated comorbidities.…”

Section: Covariatesmentioning

confidence: 99%

Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Liu

et al. 2020

Kidney International Reports

Self Cite

View full text Add to dashboard Cite

Introduction: Patients with diabetes mellitus (DM) on hemodialysis (HD) may be particularly vulnerable to infections. Methods: We used merged data from the United States Renal Data System and electronic health records data from a large US dialysis provider to retrospectively examine the association between glycemic control and infections in these patients. Adult patients with DM aged $18 years who initiated in-center maintenance HD treatment from 2006 to 2011 and survived >90 days were included. Quarterly mean time-averaged hemoglobin A1c (HbA1c) values were categorized into <5.5%, 5.5 to <6.5%, 6.5 to <7.5%, 7.5 to <8.5%, and $8.5%. We used Medicare claims to ascertain infection-related outcomes and the ESRD Death Notification to identify death from infectious cause. We used Cox proportional hazards models to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for the associations between time-averaged HbA1c categories and infectious events. Results: In a cohort of 33,753 eligible patients, those with higher HbA1c levels had higher rates of diabetic foot infections and skin and soft tissue infections, with patients with HbA1c $8.5% having 23% (95% CI, 5%, 45%) and 22% (95% CI, 5%, 42%) higher rates, respectively, compared with HbA1c 5.5 to <6.5%. Patients in the lower HbA1c categories had higher rates of infection-related and all-cause mortality (P-fortrend <0.001). Conclusion: This study highlights the need for greater attention to foot evaluation and skin and soft tissue infections among patients on HD with less than optimal diabetes control.

show abstract

“…, Patients with type 2 diabetes with ESRD undergoing haemodialysis are at very high cardiovascular risk . In these patients, poor glycaemic balance (ie, HbA1c ≥7.5% or serum glucose ≥200 mg/dL) was associated with increased cardiovascular and all‐cause mortality . Therefore, improving patients’ glycaemic balance is mandatory, often resulting in multiple daily insulin injections.…”

Section: Introductionmentioning

confidence: 99%

Effect of adding vildagliptin to insulin in haemodialysed patients with type 2 diabetes: The VILDDIAL study, a randomized, multicentre, prospective study

Munch¹,

Meyer²,

Hannedouche³

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim: To evaluate the effect of adding the dipeptidyl-peptidase-4 inhibitor vildagliptin to insulin on the glycaemic control of patients with type 2 diabetes undergoing haemodialysis.Methods: Overall, 65 insulin-treated patients with type 2 diabetes undergoing haemodialysis (HbA1c: 7.3% ± 1.1%; age: 70.5 ± 8.5 years) were randomized (1:1) either to receive vildagliptin 50 mg/day in addition to insulin (vildagliptin-insulin group) or to pursue their usual insulin regimen (insulin-only group). Continuous glucose monitoring (CGM) was performed for 48 ± 6 hours at baseline and at week 12. The primary This study was supported by Novartis Inc., France.

show abstract

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

Cited by 14 publications

References 38 publications

Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes

Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes

Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus

Effect of adding vildagliptin to insulin in haemodialysed patients with type 2 diabetes: The VILDDIAL study, a randomized, multicentre, prospective study

Contact Info

Product

Resources

About