title: Impact of atherosclerosis on the relationship of glycemic control and mortality in diabetic patients on hemodialysis.
abstract: OBJECTIVE
  The impact of preexisting cardiovascular disease (CVD) on glycemic control-improved survival in hemodialysis patients with diabetes mellitus (DM) was investigated. Glycoalbumin (GA) was used as a glycemic marker.
  
  
  METHODS
  A single-center 4-year follow-up study was performed in an observational cohort of 178 DM hemodialysis patients to analyze the relationship between GA and all-cause mortality in patients with (n = 70) and without (n = 108) CVD. The subjects were divided into three categories based on GA value at the start of study.
  
  
  RESULTS
  Baseline characteristics did not differ between the two groups of patients. During the 4-year follow-up, 24 of 108 (23.3%) CVD(-) patients and 30 of 70 (42.8%) CVD(+) patients died. The mortality was significantly higher in the CVD(+) group. Multivariate Cox analyses including GA, logCRP, age, gender, hemodialysis duration, albumin, hemoglobin, BMI, SBP, DBP, smoking habit, and SUN as independent variables showed that GA, in addition to logCRP and age, was independently associated with mortality in all patients. Kaplan-Meier analysis showed lower GA levels to be a significant predictor of lower mortality in the CVD(-) group, but not in the CVD(+) group. Multivariable-adjusted Cox proportional hazards models demonstrated a significant association between GA with allcause mortality risk in the CVD(-) group (p = 0.004), in contrast with the CVD(+) group in the same model (p = 0.842).
  
  
  CONCLUSIONS
  These results demonstrate a beneficial effect of improved glycemic control on survival in DM hemodialysis patients, which might be attenuated by the presence of CVD.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Kyoto, Japan. inaba-m@med.osaka-cu.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Maekawa
authors.forename: Senji
authors.initials: S
authors.lastname: Okuno
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Imanishi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hayashino
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis*; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017127:Glycation End Products, Advanced; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D000093423:Glycated Serum Albumin
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human