title: Glycated hemoglobin predicts overall and cardiovascular mortality in non-diabetic hemodialysis patients.
abstract: OBJECTIVE
  Besides diabetic patients, glycated hemoglobin (HbA1c) levels have been reported to predict mortality in non-diabetics patients. However, the importance of HbA1c levels in non-diabetic hemodialysis patients still remains unknown. Thus, we aimed to prospectively investigate the impact of HbA1c on all-cause and cardiovascular mortality in a large group of prevalent non-diabetic hemodialysis patients.
  
  
  METHODS
  HbA1c was measured quarterly in 489 non-diabetic prevalent hemodialysis patients. Overall and cardiovascular mortality were evaluated over a 3 year follow-up.
  
  
  RESULTS
  Mean HbA1c level was 4.88 ± 0.46% (3.5 - 6.9%). During the 28.3 ± 10.6 months follow-up period, 67 patients (13.7%) died; 31 from cardiovascular causes. In Kaplan-Meier analysis, patients in the lowest (< 4.69%) and highest HbA1c (> 5.04%) tertiles had poorer overall survival compared to the middle HbA1c tertile (p < 0.001). Adjusted Cox-regression analysis revealed that the highest HbA1c tertile was associated with both overall (HR = 3.60, 95% CI 1.57 - 8.27, p = 0.002) and cardiovascular (HR = 6.66, 95% CI 1.51 - 29.4; p = 0.01) mortality. Also, low HbA1c levels tended to be associated with overall mortality (HR = 2.26, 95% CI 0.96 - 5.29, p = 0.06).
  
  
  CONCLUSIONS
  Upper normal HbA1c levels are independently associated with cardiovascular and overall mortality in non-diabetic hemodialysis patients, whereas lower HbA1c levels are not.
authors: Division of Nephrology, Ege University, Izmir, Turkey, Division of Nephrology, University of Heidelberg, Heidelberg, Germany, and Division of Nephrology, Istanbul University, Istanbul, Turkey.
authors: Ebru Sevinc
authors: ES
authors: Ok
authors: Gulay
authors: G
authors: Asci
authors: Huseyin
authors: H
authors: Toz
authors: Eberhard
authors: E
authors: Ritz
authors: Fatih
authors: F
authors: Kircelli
authors: Mehmet Sukru
authors: MS
authors: Sever
authors: Mehmet
authors: M
authors: Ozkahya
authors: Savas
authors: S
authors: Sipahi
authors: Hamad
authors: H
authors: Dheir
authors: Devrim
authors: D
authors: Bozkurt
authors: Ziya
authors: Z
authors: Omer
authors: Osman Z
authors: OZ
authors: Sahin
authors: Muhittin
authors: M
authors: Ertilav
authors: Ercan
authors: E
authors: Ok
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D006442:Glycated Hemoglobin / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human