Glycemic control and survival of diabetic hemodialysis patients--importance of lower hemoglobin A1C levels.
OBJECTIVE
The significance of hemoglobin A1C (HbA1C) on the survival of diabetic hemodialysis patients still remains controversial. We investigated the impact of HbA1C on the survival.


METHODS
A total of 122 diabetic patients on maintenance hemodialysis (age, 59.9+/-11.9 years [mean+/-SD]; hemodialysis duration: 53+/-38 months) were surveyed (survey period: 46+/-19 months).


RESULTS
The cumulative survival of the poor glycemic control group (mean HbA1C of 3-month period > or =6.3%, n=62) was significantly lower than that of the good group (HbA1C<6.3%, n=60), as determined by Kaplan-Meier estimation (P=0.0084, log-rank test). Kaplan-Meier analysis also demonstrated that both cardiovascular and non-cardiovascular mortalities were higher in the poor group than in the good group (P=0.0545 and P=0.0453, respectively). In a multivariate Cox proportional hazard model, the mean HbA1C was a significant predictor of survival (OR 1.260 per 1.0%, 95% CI 1.020-0.579, P=0.0325).


CONCLUSIONS
Poor glycemic control is an independent predictor of poor prognosis in diabetic hemodialysis patients. HbA1C is a clinically useful parameter for identifying the risk for mortality, both for cardiovascular and non-cardiovascular mortality, and that careful management of glycemic control by use of HbA1C is important.
Ishimura
E
E
Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. ish@med.osaka-cu.ac.jp
Okuno
S
S
Kono
K
K
Fujino-Kato
Y
Y
Maeno
Y
Y
Kagitani
S
S
Tsuboniwa
N
N
Nagasue
K
K
Maekawa
K
K
Yamakawa
T
T
Inaba
M
M
Nishizawa
Y
Y
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003925:Diabetic Angiopathies / Q000097:blood / Q000401:mortality; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D016019:Survival Analysis; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin