Glycemic control is a predictor of survival for diabetic patients on hemodialysis.
OBJECTIVE
To investigate the impact of glycemic control on the survival of diabetic subjects with end-stage renal disease (ESRD) starting hemodialysis treatment.


METHODS
This single-center prospective observational study enrolled 150 diabetic ESRD subjects (109 men and 41 women; age at hemodialysis initiation, 60.5 +/- 10.2 years) at start of hemodialysis between January 1989 and December 1997. The subjects were divided into groups according to their glycemic control level at inclusion as follows: good HbA1c <7.5%, n = 93 (group G), and poor HbA1c > or = 7.5%, n = 57 (group P); and survival was followed until December 1999, with a mean follow-up period of 2.7 years.


RESULTS
Group G had better survival than group P (the control group) (P = 0.008). At inclusion, there was no significant difference in age, sex, systolic blood pressure (SBP), BMI, cardio-to-thoracic ratio (CTR) on chest X-ray, and serum creatinine (Cre) or hemoglobin (Hb) levels between the two groups. After adjustment for age and sex, HbA1c was a significant predictor of survival (hazard ratio 1. 133 per 1.0% increment of HbA1c, 95% CI 1.028-1.249, P = 0.012), as were Cre and CTR.


CONCLUSIONS
Good glycemic control (HbA1c <7.5%) predicts better survival of diabetic ESRD patients starting hemodialysis treatment.
Morioka
T
T
Department of Internal Medicine, Osaka City University Graduate Medical School, Osaka, Japan.
Emoto
M
M
Tabata
T
T
Shoji
T
T
Tahara
H
H
Kishimoto
H
H
Ishimura
E
E
Nishizawa
Y
Y
D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate; D013997:Time Factors
D001786:Blood Glucose; D003404:Creatinine; D006442:Glycated Hemoglobin; D006454:Hemoglobins