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. 2011 May;6(5):1041-8.
doi: 10.2215/CJN.08921010. Epub 2011 Apr 21.

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus

Uyen Duong  1 , Rajnish Mehrotra, Miklos Z Molnar, Nazanin Noori, Csaba P Kovesdy, Allen R Nissenson, Kamyar Kalantar-Zadeh
Affiliations

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus

Uyen Duong et al. Clin J Am Soc Nephrol. 2011 May.

Abstract

Background and objectives: The optimal _target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients.

Design, setting, participants, & measurements: We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007.

Results: We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r=0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively.

Conclusions: Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.

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Figures

Figure 1.
Figure 1.
HRs of all-cause mortality of the entire range of A1C in 2798 PD patients using standard Cox (A) and time-averaged (B) models. Case-mix model is adjusted for age, sex, race/ethnicity, pre-existing comorbid states, tobacco smoking, dialysis vintage, primary insurance, and marital status. Malnutrition-inflammation complex syndrome (MICS)–adjusted model includes all of the case-mix covariates as well as body mass index and 10 laboratory variables of nutrition and inflammation.
Figure 2.
Figure 2.
HRs of all-cause mortality for the dichotomized A1C >7% in different subgroups of 2798 PD patients. Adjusted model is controlled for age, sex, race/ethnicity, pre-existing comorbid states, tobacco smoking, dialysis vintage, primary insurance, marital status, body mass index, and 10 laboratory variables of nutrition and inflammation.
Figure 3.
Figure 3.
HRs of all-cause mortality of serum glucose in 2575 diabetic PD patients using standard Cox (A) and time-averaged (B) models. Case-mix model is adjusted for age, sex, race/ethnicity, pre-existing comorbid states, tobacco smoking, dialysis vintage, primary insurance, and marital status. Malnutrition-inflammation complex syndrome (MICS)–adjusted model includes all of the case-mix covariates as well as body mass index and 10 laboratory variables of nutrition and inflammation.
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References

    1. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383–393, 2003 - PubMed
    1. United States Renal Data System: Excerpts from the USRDS 2005 Annual Data Report: Atlas of End-Stage Renal Disease in the United States,National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Am J Kid Dis 47[Suppl 1]: 1–286, 2006 - PubMed
    1. Friedman EA: Renal syndromes in diabetes. Endocrinol Metab Clin North Am 25: 293–324, 1996 - PubMed
    1. Abbott KC, Bakris GL: Treatment of the diabetic patient: Focus on cardiovascular and renal risk reduction. Prog Brain Res 139: 289–298, 2002 - PubMed
    1. Kimmel PL, Varela MP, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Amarashinge A, Mishkin GJ, Cruz I, Veis JH: Interdialytic weight gain and survival in hemodialysis patients: Effects of duration of ESRD and diabetes mellitus. Kidney Int 57: 1141–1151, 2000 - PubMed

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