Cargando…

Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

OBJECTIVE: Lowering hemoglobin A(1c) to <7% reduces the risk of microvascular complications of diabetes, but the importance of maintaining this target in diabetes patients with kidney failure is unclear. We evaluated the relationship between A(1c) levels and mortality in an international prospect...

Descripción completa

Detalles Bibliográficos
Autores principales: Ramirez, Sylvia Paz B., McCullough, Keith P., Thumma, Jyothi R., Nelson, Robert G., Morgenstern, Hal, Gillespie, Brenda W., Inaba, Masaaki, Jacobson, Stefan H., Vanholder, Raymond, Pisoni, Ronald L., Port, Fritz K., Robinson, Bruce M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507600/
https://www.ncbi.nlm.nih.gov/pubmed/22912431
http://dx.doi.org/10.2337/dc12-0573
_version_ 1782251090368004096
author Ramirez, Sylvia Paz B.
McCullough, Keith P.
Thumma, Jyothi R.
Nelson, Robert G.
Morgenstern, Hal
Gillespie, Brenda W.
Inaba, Masaaki
Jacobson, Stefan H.
Vanholder, Raymond
Pisoni, Ronald L.
Port, Fritz K.
Robinson, Bruce M.
author_facet Ramirez, Sylvia Paz B.
McCullough, Keith P.
Thumma, Jyothi R.
Nelson, Robert G.
Morgenstern, Hal
Gillespie, Brenda W.
Inaba, Masaaki
Jacobson, Stefan H.
Vanholder, Raymond
Pisoni, Ronald L.
Port, Fritz K.
Robinson, Bruce M.
author_sort Ramirez, Sylvia Paz B.
collection PubMed
description OBJECTIVE: Lowering hemoglobin A(1c) to <7% reduces the risk of microvascular complications of diabetes, but the importance of maintaining this target in diabetes patients with kidney failure is unclear. We evaluated the relationship between A(1c) levels and mortality in an international prospective cohort study of hemodialysis patients. RESEARCH DESIGN AND METHODS: Included were 9,201 hemodialysis patients from 12 countries (Dialysis Outcomes and Practice Patterns Study 3 and 4, 2006–2010) with type 1 or type 2 diabetes and at least one A(1c) measurement during the first 8 months after study entry. Associations between A(1c) and mortality were assessed with Cox regression, adjusting for potential confounders. RESULTS: The association between A(1c) and mortality was U-shaped. Compared with an A(1c) of 7–7.9%, the hazard ratios (95% CI) for A(1c) levels were 1.35 (1.09–1.67) for <5%, 1.18 (1.01–1.37) for 5–5.9%, 1.21 (1.05–1.41) for 6–6.9%, 1.16 (0.94–1.43) for 8–8.9%, and 1.38 (1.11–1.71) for ≥9.0%, after adjustment for age, sex, race, BMI, serum albumin, years of dialysis, serum creatinine, 12 comorbid conditions, insulin use, hemoglobin, LDL cholesterol, country, and study phase. Diabetes medications were prescribed for 35% of patients with A(1c) <6% and not prescribed for 29% of those with A(1c) ≥9%. CONCLUSIONS: A(1c) levels strongly predicted mortality in hemodialysis patients with type 1 or type 2 diabetes. Mortality increased as A(1c) moved further from 7–7.9%; thus, target A(1c) in hemodialysis patients may encompass values higher than those recommended by current guidelines. Modifying glucose-lowering medicines for dialysis patients to target A(1c) levels within this range may be a modifiable practice to improve outcomes.
format Online
Article
Text
id pubmed-3507600
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher American Diabetes Association
record_format MEDLINE/PubMed
spelling pubmed-35076002013-12-01 Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Ramirez, Sylvia Paz B. McCullough, Keith P. Thumma, Jyothi R. Nelson, Robert G. Morgenstern, Hal Gillespie, Brenda W. Inaba, Masaaki Jacobson, Stefan H. Vanholder, Raymond Pisoni, Ronald L. Port, Fritz K. Robinson, Bruce M. Diabetes Care Original Research OBJECTIVE: Lowering hemoglobin A(1c) to <7% reduces the risk of microvascular complications of diabetes, but the importance of maintaining this target in diabetes patients with kidney failure is unclear. We evaluated the relationship between A(1c) levels and mortality in an international prospective cohort study of hemodialysis patients. RESEARCH DESIGN AND METHODS: Included were 9,201 hemodialysis patients from 12 countries (Dialysis Outcomes and Practice Patterns Study 3 and 4, 2006–2010) with type 1 or type 2 diabetes and at least one A(1c) measurement during the first 8 months after study entry. Associations between A(1c) and mortality were assessed with Cox regression, adjusting for potential confounders. RESULTS: The association between A(1c) and mortality was U-shaped. Compared with an A(1c) of 7–7.9%, the hazard ratios (95% CI) for A(1c) levels were 1.35 (1.09–1.67) for <5%, 1.18 (1.01–1.37) for 5–5.9%, 1.21 (1.05–1.41) for 6–6.9%, 1.16 (0.94–1.43) for 8–8.9%, and 1.38 (1.11–1.71) for ≥9.0%, after adjustment for age, sex, race, BMI, serum albumin, years of dialysis, serum creatinine, 12 comorbid conditions, insulin use, hemoglobin, LDL cholesterol, country, and study phase. Diabetes medications were prescribed for 35% of patients with A(1c) <6% and not prescribed for 29% of those with A(1c) ≥9%. CONCLUSIONS: A(1c) levels strongly predicted mortality in hemodialysis patients with type 1 or type 2 diabetes. Mortality increased as A(1c) moved further from 7–7.9%; thus, target A(1c) in hemodialysis patients may encompass values higher than those recommended by current guidelines. Modifying glucose-lowering medicines for dialysis patients to target A(1c) levels within this range may be a modifiable practice to improve outcomes. American Diabetes Association 2012-12 2012-11-14 /pmc/articles/PMC3507600/ /pubmed/22912431 http://dx.doi.org/10.2337/dc12-0573 Text en © 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Original Research
Ramirez, Sylvia Paz B.
McCullough, Keith P.
Thumma, Jyothi R.
Nelson, Robert G.
Morgenstern, Hal
Gillespie, Brenda W.
Inaba, Masaaki
Jacobson, Stefan H.
Vanholder, Raymond
Pisoni, Ronald L.
Port, Fritz K.
Robinson, Bruce M.
Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title_full Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title_fullStr Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title_full_unstemmed Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title_short Hemoglobin A(1c) Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
title_sort hemoglobin a(1c) levels and mortality in the diabetic hemodialysis population: findings from the dialysis outcomes and practice patterns study (dopps)
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507600/
https://www.ncbi.nlm.nih.gov/pubmed/22912431
http://dx.doi.org/10.2337/dc12-0573
work_keys_str_mv AT ramirezsylviapazb hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT mcculloughkeithp hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT thummajyothir hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT nelsonrobertg hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT morgensternhal hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT gillespiebrendaw hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT inabamasaaki hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT jacobsonstefanh hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT vanholderraymond hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT pisonironaldl hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT portfritzk hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps
AT robinsonbrucem hemoglobina1clevelsandmortalityinthediabetichemodialysispopulationfindingsfromthedialysisoutcomesandpracticepatternsstudydopps