Correlates of low hemoglobin A1c in maintenance hemodialysis patients.
OBJECTIVE
The optimal target for glycemic control has not been established for diabetic maintenance hemodialysis (MHD) patients.


METHODS
A 6-year cohort (October 2001- December 2006) of 347 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality. Death hazard ratios (HR) were estimated using Cox regressions and cubic splines.


RESULTS
In these 347 patients (age, 59 ± 11 years; 49 % women; 28 % African Americans; and 55 % Hispanics), each 0.5 % decline in HbA1c below 6 % was associated with a 4.7 times higher death risk (HR = 4.7; 95 % CI 1.7-12.7) in the fully adjusted model. Factors associated with lower HbA1c levels (<6 % compared to 6-7 %) were: Hispanic ethnicity (OR = 2.9; 95 % CI 1.1-7.9), higher mid-arm muscle circumstance (OR = 1.1; 95 % CI 1.0-1.3), higher total iron-binding capacity (OR = 1.03; 95 % CI 1.01-1.05), and higher iron saturation ratio (OR = 1.14; 95 % CI 1.03-1.26). HbA1c levels >7 % showed a consistent trend toward elevated mortality risk (HR = 1.18; 95 % CI 0.99-1.41) after multivariate adjustment.


CONCLUSIONS
In diabetic MHD patients with burnt-out diabetes, characterized by HbA1c <6 %, even lower HbA1c levels are associated with significantly higher death risk. Additional studies are needed to determine the optimal target for HbA1c levels in different subgroups of diabetic MHD patients.
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Youngmee
Y
Kim
Jong Chan
JC
Park
Miklos Z
MZ
Molnar
Anuja
A
Shah
Debbie
D
Benner
Csaba P
CP
Kovesdy
Joel D
JD
Kopple
Kamyar
K
Kalantar-Zadeh
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis
D015415:Biomarkers; D006442:Glycated Hemoglobin