Visit-to-visit HbA1c variability is associated with poor prognosis in peritoneal dialysis patients with type 2 diabetes mellitus

BACKGROUND: The prognosis of diabetic peritoneal dialysis patients is poor. HbA(1c) serves as a crucial indicator for monitoring blood glucose control in patients with diabetes. Nevertheless, the relationship between visit-to-visit HbA(1c) variability and prognosis in peritoneal dialysis with diabetes remains unclear. METHODS: All participants were categorized into 3 groups based on the HbA(1c) variability score (HVS), which is the frequency of 0.5% (5.5 mmol/mol) alter in visit-to-visit HbA(1c) values. Then, the hazard ratio to HVS with all-cause mortality was analyzed using the Cox hazard model, followed by the Fine-Gray competing risk model for major adverse cardiovascular events. Subgroup and sensitivity analysis were conducted to ascertain the robustness of the findings. RESULTS: Eight hundred twenty patients with type 2 diabetes were finally enrolled in this study from 2,855 participants with a mean age of 56.9 ± 14.6 years and a median follow-up time of 44 months [IQR: 27–70], death occurred in 496 (60.2%) individuals. Compared with the lowest category (HVS < 1/3) after being adjusted by potential confounding factors, the hazard ratio for all-cause mortality was 4.59 (3.74–5.64) and the sub-distribution hazard ratio for major adverse cardiovascular events was 1.91 (1.46–2.51) of the highest category (HVS ≥ 2/3). Subgroup interaction and sensitivity analysis, including the adjustment for variables such as time-weighted average HbA(1c), HbA(1c) measurement times and expansion, confirmed the reliability of the results. CONCLUSION: The HVS is related to the risk of poor prognosis in peritoneal dialysis with type 2 diabetes mellitus, independently of clinical multiple variables, and is a novel indicator with clinical guidance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-023-03348-2.