This article is more than 5 years old. Information may no longer be current.
DOPPS: HbA1c predicted mortality in hemodialysis patients with diabetes
Click Here to Manage Email Alerts
It is known that reducing HbA1c levels to less than 7% results in a decreased risk for microvascular complications of diabetes, but the importance of continuing this target in patients undergoing hemodialysis is uncertain. Study results indicate that this population may have higher values compared with the current guidelines.
“Diabetes is present in more than 66% of US hemodialysis patients and is a major contributor to the increased morbidity and mortality in this population,” the researchers wrote.
The Dialysis Outcomes Practice Patterns Study (DOPPS) was a prospective cohort study consisting of randomly selected in-center hemodialysis patients from 12 countries (n=9,201). During the first 8 months after enrollment, patients had at least one HbA1c measurement.
After adjustments for age, sex, race, BMI, serum albumin, years of dialysis, serum creatinine, 12 comorbid conditions, insulin use, hemoglobin, LDL cholesterol, country and study phase, the researchers compared HRs for HbA1c levels between 7% and 7.9% with varying values.
For HbA1c levels ,5%, HR=1.35 (95% CI, 1.09-1.67); and for HbA1c levels between 5% and 5.9%, HR=1.18 (95% CI, 1.01-1.37). Further data found that for HbA1c levels between 6% and 6.9%, HR=1.21 (95% CI, 1.05-1.41); between 8% and 8.9%, HR=1.16 (95% CI, 0.94-1.43); and ≥9%, HR=1.38 (95% CI, 1.11-1.71).
“We also examined whether diabetes treatment modified the estimated effect of A1c on mortality,” researchers wrote.
According to researchers, diabetes medications were prescribed for 35% of patients with HbA1c levels <6% and not prescribed for 29% of those with HbA1c levels ≥9%.
The researchers said the strong association of both high and low HbA1c levels with elevated mortality are cause for an emphasis on proper HbA1c measurements in the management of patients undergoing dialysis and suggest clinical trials to compare target goals.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts