A1C and Survival in Maintenance Hemodialysis Patients
Kamyar Kalantar-Zadeh,Joel D. Kopple,Deborah L. Regidor,Jennie Jing,Christian S. Shinaberger,Jason Aronovitz,Charles J. McAllister,David J. Whellan,Kumar Sharma +8 more
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TLDR
In this paper, the optimal target for glycemic control has not been established in diabetic dialysis patients, and the authors investigate the relationship between poor glycemia control and increased death risk.Abstract:
OBJECTIVE —The optimal target for glycemic control has not been established in diabetic dialysis patients.
RESEARCH DESIGN AND METHODS —To address this question, the national database of a large dialysis organization (DaVita) was analyzed via time-dependent survival models with repeated measures.
RESULTS —Of 82,933 patients undergoing maintenance hemodialysis (MHD) in DaVita outpatient clinics over 3 years (July 2001 through June 2004), 23,618 diabetic MHD patients had A1C measurements at least once. Unadjusted survival analyses indicated paradoxically lower death hazard ratios (HRs) with higher A1C values. However, after adjusting for potential confounders (demographics, dialysis vintage, dose, comorbidity, anemia, and surrogates of malnutrition and inflammation), higher A1C values were incrementally associated with higher death risks. Compared with A1C in the 5–6% range, the adjusted all-cause and cardiovascular death HRs for A1C ≥10% were 1.41 (95% CI 1.25–1.60) and 1.73 (1.44–2.08), respectively ( P 11.0 g/dl). In subgroup analyses, the association between A1C >6% and increased death risk was more prominent among younger patients, those who had undergone dialysis for >2 years, and those with higher protein intake (>1 g · kg−1 · day−1), blood hemoglobin (>11 g/dl), or serum ferritin values (>500 ng/ml).
CONCLUSIONS —In diabetic MHD patients, the apparently counterintuitive association between poor glycemic control and greater survival is explained by such confounders as malnutrition and anemia. All things equal, higher A1C is associated with increased death risk. Lower A1C levels not related to malnutrition or anemia appear to be associated with improved survival in MHD patients.read more
Citations
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KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update
Rudolf W. Bilous,JM Gonzalez-Campoy,JE Fradkin,Michael Mauer,Mark E. Molitch,Andrew S. Narva,Robert G. Nelson,Kumar Sharma,Katherine R. Tuttle,Michael V. Rocco,Jeffrey S. Berns,Timothy J Wilt,Areef Ishani,Thomas S. Rector,Yelena Slinin,Patrick Fitzgerald,M Carlyle +16 more
TL;DR: The 2012 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Diabetes and Chronic Kidney disease (CKD) is intended to assist the practitioner caring for patients with diabetes and CKD.
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Diabetic Kidney Disease: A Report From an ADA Consensus Conference
Katherine R. Tuttle,George L. Bakris,Rudolf W. Bilous,Jane L. Chiang,Ian H. de Boer,Jordi Goldstein-Fuchs,Irl B. Hirsch,Kamyar Kalantar-Zadeh,Andrew S. Narva,Sankar D. Navaneethan,Joshua J. Neumiller,Uptal D. Patel,Robert E. Ratner,Adam Whaley-Connell,Mark E. Molitch +14 more
TL;DR: This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
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Diabetic kidney disease: a report from an ADA Consensus Conference.
Katherine R. Tuttle,George L. Bakris,Rudolf W. Bilous,Jane L. Chiang,Ian H. de Boer,Jordi Goldstein-Fuchs,Irl B. Hirsch,Kamyar Kalantar-Zadeh,Andrew S. Narva,Sankar D. Navaneethan,Joshua J. Neumiller,Uptal D. Patel,Robert E. Ratner,Adam Whaley-Connell,Mark E. Molitch +14 more
TL;DR: This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
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Fluid Retention Is Associated With Cardiovascular Mortality in Patients Undergoing Long-Term Hemodialysis
Kamyar Kalantar-Zadeh,Deborah L. Regidor,Csaba P. Kovesdy,David B. Van Wyck,Suphamai Bunnapradist,Tamara B. Horwich,Gregg C. Fonarow +6 more
TL;DR: In he modialysis patients, greater fluid retention between 2 subsequent hemodialysis treatment sessions is associated with higher risk of all-cause and cardiovascular death.
Journal ArticleDOI
Comparison of glycated albumin and hemoglobin A1c levels in diabetic subjects on hemodialysis
Todd P. Peacock,Zak K. Shihabi,Anthony J. Bleyer,E.L. Dolbare,Joyce R. Byers,M. A. Knovich,Jorge Calles-Escandon,Greg Russell,Barry I. Freedman +8 more
TL;DR: In diabetic hemodialysis patients, hemoglobin A(1c) levels significantly underestimate glycemic control while those of glycated albumin more accurately reflect this control.
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Kamyar Kalantar-Zadeh,Kamyar Kalantar-Zadeh,T. Alp Ikizler,Gladys Block,Morrel M. Avram,Joel D. Kopple,Joel D. Kopple,Joel D. Kopple +7 more
TL;DR: Because MICS leads to a low body mass index, hypocholesterolemia, hypocreatininemia, and hypohomocysteinemia, a "reverse epidemiology" of cardiovascular risks can occur in dialysis patients, obesity, hypercholesterolesmia, and increased blood levels of creatinine and homocysteine appear to be protective and paradoxically associated with a better outcome.
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