The Effect of Glycated Hemoglobin and Albumin-Corrected Glycated Serum Protein on Mortality in Diabetic Patients Receiving Continuous Peritoneal Dialysis.
OBJECTIVE
To explore the effect of glycated hemoglobin (HbA1c) and albumin-corrected glycated serum proteins (Alb-GSP) on the mortality of diabetic patients receiving continuous peritoneal dialysis (PD).


METHODS
In this single-center retrospective cohort study, incident diabetic PD patients from January 1, 2006, to December 31, 2010, were recruited, and followed up until December 31, 2011. The effect of HbA1c and Alb-GSP on mortality was evaluated by Cox proportional hazards models.


RESULTS
A total of 200 patients (60% male, mean age 60.3 ± 10.6 years) with a mean follow-up of 29.0 months (range: 4.3 - 71.5 months) were recruited. Sixty-four patients died during the follow-up period, of whom 21 died of cardiovascular disease (CVD). Mean values for HbA1c, GSP and Alb-GSP were 6.7% (range: 4.1 - 12.5%), 202 μmol/L (range: 69 - 459 μmol/L), and 5.78 μmol/g (range: 2.16 - 14.98 μmol/g), respectively. The concentrations of GSP and Alb-GSP were closely correlated with HbA1c (r = 0.41, p < 0.001 and r = 0.45, p < 0.001, respectively). In multivariate Cox proportional hazards models, patients with HbA1c ≥ 8% were associated with increased risk of all-cause mortality (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.06 - 4.96, p = 0.04), but no increased mortality in patients with 6.0% ≤ HbA1c ≤ 7.9%. Patients with Alb-GSP ≤ 4.50 μmol/g had increased all-cause and non-cardiovascular mortality (HR = 2.42, 95% CI: 1.13 - 5.19, p = 0.02; and HR = 2.98, 95% CI: 1.05 - 8.48, p = 0.04 respectively).


CONCLUSIONS
Increased HbA1c and decreased Alb-GSP may be associated with poorer survival in diabetic PD patients, with a non-significant trend observed for poorer survival with the highest level of Alb-GSP.
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China.
Fenfen
F
Peng
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China.
Xi
X
Xia
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China.
Feng
F
He
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China.
Zhijian
Z
Li
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China hfxyl@163.net.
Fengxian
F
Huang
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Nephrology, Ministry of Health, Guangzhou, China.
Xueqing
X
Yu
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D017127:Glycation End Products, Advanced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate; D000093423:Glycated Serum Albumin
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human
Diabetes; glycated hemoglobin; glycated serum proteins; mortality; peritoneal dialysis