Impact of Glycemic Control on Survival of Diabetic Patients on Chronic Regular Hemodialysis

Abstract

OBJECTIVE—To investigate the impact of glycemic control during regular hemodialysis on the survival of diabetic patients with chronic kidney disease (CKD) in a longitudinal observational study. RESEARCH DESIGN AND METHODS—A total of 114 diabetic CKD patients on hemodialysis at Inoue Hospital (Suita, Japan) were surveyed from May 1995 to December 2002 (survey period 45.5 ± 29.3 [means ± SD] months). All subjects were categorized into three groups by mean HbA1c (A1C) level during the 3-month period on hemodialysis preceding entry, as follows: good (A1C <6.5%, 5.7 ± 0.4%, n = 34), fair (6.5 ≤ A1C < 8.0%, 7.2 ± 0.4%, n = 39), and poor (A1C ≥8.0%, 9.2 ± 0.9%, n = 41) A1C groups. RESULTS—There were no significant differences in age at entry, initiation of hemodialysis, duration of hemodialysis, blood pressure, cardiothoracic ratio, serum creatinine level, or hemoglobin level among the three groups. The cumulative survival of the poor A1C group during the survey was significantly lower than that of the fair and good A1C groups as determined by Kaplan-Meier estimation (P = 0.041, log-rank test). In a multivariate Cox proportional hazard model, both poor A1C group (hazard ratio 2.889, P = 0.010) and mean A1C (1.260 per 1.0%, P = 0.003) were significant predictors of survival. CONCLUSIONS—In diabetic CKD patients on regular hemodialysis, poor glycemic control is an independent predictor of prognosis. This finding indicates the importance of careful management of glycemic control even after initiation of hemodialysis.

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

“…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…”

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

“…In addition, limited studies showed an association of poor glycemic control with poor survival on chronic dialysis (8,9). However, several studies showed no correlation…”

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

“…31 Although in the population with no CKD a strict control of diabetes is associated with a reduction in chronic complications 32 , in the HD population, a stricter control of glycemia protected patients against death due to infectious processes, but not against those due to cardiovascular events. 33 Dyslipidemia in CKD and its association with CVD has been extensively discussed, and several mechanisms relating that abnormality to systemic inflammation and to atherosclerosis triggers have been shown. 34 In patients with non-dialytic CKD, the reduction in cholesterol levels with statins has been associated with a reduction in coronary events, but had no influence on cardiovascular mortality.…”