title: Unique hemoglobin A1c level distribution and its relationship with mortality in diabetic hemodialysis patients.
abstract: Diabetic hemodialysis patients with hemoglobin A1c (HbA1c) levels below 6.5% and over 8.0% face a higher mortality risk. To determine the optimal glycemic control in Japanese patients, we examined the association between HbA1c and mortality in 2,300 Japanese diabetic patients on maintenance hemodialysis with HbA1c levels determined at enrollment in the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS) phases 2-5, using Cox regression analysis with adjustment for baseline age, sex, dialysis vintage, 12 general comorbidities, hemoglobin, albumin and creatinine levels, and insulin use; stratification by JDOPPS phase; and facility clustering taken into account. Overall, 54% of patients had HbA1c levels under 6.0, including 14% with HbA1c levels under 5.0. Insulin or oral diabetes medications were used less frequently in patients with higher HbA1c levels. The dependence of mortality on HbA1c level was U shaped. When the group with the lowest mortality (HbA1c 6.0-7.0) was used as a reference, the hazard ratios for HbA1c categories under 5.0, 5.0-6.0, 7.0 to under 8.0, and 8.0 and greater were, respectively, 1.56 (95% confidence interval, 1.05-2.33), 1.26 (0.92-1.71), 1.23 (0.79-1.89), and 2.10 (1.32-3.33) in the adjusted model. The HbA1c level was not associated with self-reported hypoglycemic episodes in JDOPPS phase 5. The HbA1c levels in diabetic hemodialysis patients differ considerably between Japan and those reported from Western countries. Thus, our findings highlight the importance of domestic guidelines for glycemic control by race and country.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan. Electronic address: hoshino@toranomon.gr.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Larkina
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Karaboyas
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bieber
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.affiliation: Department of Nephrology and Endocrinology, Tokai University, Kanagawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012709:Serum Albumin
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D012709:Serum Albumin; C517652:hemoglobin A1c protein, human
keywords: Asian; DOPPS; Japanese; diabetes; dialysis; hemoglobin A1c; mortality; practice patterns