Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus

Uyen Duong, Rajnish Mehrotra, Miklos Z. Molnar, Nazanin Noori, Csaba Kovesdy, Allen R. Nissenson, Kamyar Kalantar-Zadeh

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Abstract

Summary Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r =0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively. Conclusions Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.& copy 2011 by the American Society of Nephrology.

Original languageEnglish (US)
Pages (from-to)1041-1048
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number5
DOIs
StatePublished - May 1 2011

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Peritoneal Dialysis
Diabetes Mellitus
Survival
Mortality
Cause of Death
Hemoglobins
Glucose
Serum
Hyperglycemia
Blood Glucose
Dialysis
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus. / Duong, Uyen; Mehrotra, Rajnish; Molnar, Miklos Z.; Noori, Nazanin; Kovesdy, Csaba; Nissenson, Allen R.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 5, 01.05.2011, p. 1041-1048.

Research output: Contribution to journalArticle

Duong, Uyen ; Mehrotra, Rajnish ; Molnar, Miklos Z. ; Noori, Nazanin ; Kovesdy, Csaba ; Nissenson, Allen R. ; Kalantar-Zadeh, Kamyar. / Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 5. pp. 1041-1048.
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AU - Duong, Uyen

AU - Mehrotra, Rajnish

AU - Molnar, Miklos Z.

AU - Noori, Nazanin

AU - Kovesdy, Csaba

AU - Nissenson, Allen R.

AU - Kalantar-Zadeh, Kamyar

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N2 - Summary Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r =0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively. Conclusions Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.& copy 2011 by the American Society of Nephrology.

AB - Summary Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r =0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively. Conclusions Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.& copy 2011 by the American Society of Nephrology.

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