Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis
- Tomoaki Morioka, MD1,
- Masanori Emoto, MD1,
- Tsutomu Tabata, MD2,
- Tetsuo Shoji, MD1,
- Hideki Tahara, MD1,
- Hiroshi Kishimoto, MD2,
- Eiji Ishimura, MD1 and
- Yoshiki Nishizawa, MD1
- 1Metabolism, Endocrinology, and Molecular Medicine, Department of Internal Medicine, Osaka City University Graduate Medical School, Osaka
- 2Department of Internal Medicine, Inoue Hospital, Suita, Japan
Abstract
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 HbA1c <7.5%, n = 93 (group G), and poor HbA1c ≥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, HbA1c was a significant predictor of survival (hazard ratio 1.133 per 1.0% increment of HbA1c, 95% CI 1.028–1.249, P = 0.012), as were Cre and CTR.
CONCLUSIONS—Good glycemic control (HbA1c <7.5%) predicts better survival of diabetic ESRD patients starting hemodialysis treatment.
- 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
Footnotes
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Address correspondence and reprint requests to Masanori Emoto, Metabolism, Endocrinology, and Molecular Medicine, Department of Internal Medicine, Osaka City University Graduate Medical School, 1-4-3, Asahi-machi, Abeno-ku, Osaka, Japan, 545-8585. E-mail: memoto{at}med.osaka-cu.ac.jp.
Received for publication 17 October 2000 and accepted in revised form 19 January 2001.
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