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Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis

¹ Metabolism, Endocrinology, and Molecular Medicine, Department of Internal Medicine, Osaka City University Graduate Medical School, Osaka
² Department of Internal Medicine, Inoue Hospital, Suita, Japan

OBJECTIVE—To investigate the impact of glycemic control on the survival of diabetic subjects with end-stage renal disease (ESRD) starting hemodialysis treatment.

RESEARCH DESIGN AND METHODS—This single-center prospective observational study enrolled 150 diabetic ESRD subjects (109 men and 41 women; age at hemodialysis initiation, 60.5 ± 10.2 years) at start of hemodialysis between January 1989 and December 1997. The subjects were divided into groups according to their glycemic control level at inclusion as follows: good HbA_1c <7.5%, n = 93 (group G), and poor HbA_1c 7.5%, n = 57 (group P); and survival was followed until December 1999, with a mean follow-up period of 2.7 years.

RESULTS—Group G had better survival than group P (the control group) (P = 0.008). At inclusion, there was no significant difference in age, sex, systolic blood pressure (SBP), BMI, cardio-to-thoracic ratio (CTR) on chest X-ray, and serum creatinine (Cre) or hemoglobin (Hb) levels between the two groups. After adjustment for age and sex, HbA_1c was a significant predictor of survival (hazard ratio 1.133 per 1.0% increment of HbA_1c, 95% CI 1.028–1.249, P = 0.012), as were Cre and CTR.

CONCLUSIONS—Good glycemic control (HbA_1c <7.5%) predicts better survival of diabetic ESRD patients starting hemodialysis treatment.

Abbreviations: Cre, creatinine • CTR, cardio-to-thoracic ratio • DCCT, Diabetes Control and Complications Trial • ESRD, end-stage renal disease • HR, hazard ratio • OHA, oral hypoglycemic agents • SBP, systolic blood pressure • T-chol, total cholesterol • TP, total protein • UKPDS, U.K. Prospective Diabetes Study

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