Advanced search
1 file | 248.48 KB

Hemoglobin A1c levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

(2012) DIABETES CARE. 35(12). p.2527-2532
Author
Organization
Abstract
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.
Keywords
CHRONIC-RENAL-FAILURE, GLYCATED ALBUMIN, SURVIVAL, RISK, GLYCEMIC CONTROL

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 248.48 KB

Citation

Please use this url to cite or link to this publication:

Chicago
Ramirez, Sylvia Paz B, Keith P Mccullough, Jyothi R Thumma, Robert G Nelson, Hal Morgenstern, Brenda W Gillespie, Masaaki Inaba, et al. 2012. “Hemoglobin A1c Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS).” Diabetes Care 35 (12): 2527–2532.
APA
Ramirez, S. P. B., Mccullough, K. P., Thumma, J. R., Nelson, R. G., Morgenstern, H., Gillespie, B. W., Inaba, M., et al. (2012). Hemoglobin A1c levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS). DIABETES CARE, 35(12), 2527–2532.
Vancouver
1.
Ramirez SPB, Mccullough KP, Thumma JR, Nelson RG, Morgenstern H, Gillespie BW, et al. Hemoglobin A1c levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS). DIABETES CARE. 2012;35(12):2527–32.
MLA
Ramirez, Sylvia Paz B, Keith P Mccullough, Jyothi R Thumma, et al. “Hemoglobin A1c Levels and Mortality in the Diabetic Hemodialysis Population: Findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS).” DIABETES CARE 35.12 (2012): 2527–2532. Print.
@article{3095586,
  abstract     = {OBJECTIVE-Lowering hemoglobin A(1c) to {\textlangle}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 {\textlangle}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 {\textrangle}= 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) {\textlangle}6\% and not prescribed for 29\% of those with A(1c) {\textrangle}= 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.},
  author       = {Ramirez, Sylvia Paz B and Mccullough, Keith P and Thumma, Jyothi R and Nelson, Robert G and Morgenstern, Hal and Gillespie, Brenda W and Inaba, Masaaki and Jacobson, Stefan H and Vanholder, Raymond and Pisoni, Ronald L and Port, Fritz K and Robinson, Bruce M},
  issn         = {0149-5992},
  journal      = {DIABETES CARE},
  language     = {eng},
  number       = {12},
  pages        = {2527--2532},
  title        = {Hemoglobin A1c levels and mortality in the diabetic hemodialysis population: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)},
  url          = {http://dx.doi.org/10.2337/dc12-0573},
  volume       = {35},
  year         = {2012},
}

Altmetric
View in Altmetric
Web of Science
Times cited: