title: Glycemic control and survival of diabetic hemodialysis patients--importance of lower hemoglobin A1C levels.
abstract: 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.
authors.affiliation: 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
authors.forename: E
authors.initials: E
authors.lastname: Ishimura
authors.forename: S
authors.initials: S
authors.lastname: Okuno
authors.forename: K
authors.initials: K
authors.lastname: Kono
authors.forename: Y
authors.initials: Y
authors.lastname: Fujino-Kato
authors.forename: Y
authors.initials: Y
authors.lastname: Maeno
authors.forename: S
authors.initials: S
authors.lastname: Kagitani
authors.forename: N
authors.initials: N
authors.lastname: Tsuboniwa
authors.forename: K
authors.initials: K
authors.lastname: Nagasue
authors.forename: K
authors.initials: K
authors.lastname: Maekawa
authors.forename: T
authors.initials: T
authors.lastname: Yamakawa
authors.forename: M
authors.initials: M
authors.lastname: Inaba
authors.forename: Y
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin