Abstract: TH-PO723

Hemoglobin A1c Levels and Infection Risk Among Dialysis Patients

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Rhee, Connie, University of California Irvine, Huntington Beach, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • You, Amy Seung, University of California, Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Brunelli, Steven M., DaVita Clinical Research, Needham, Massachusetts, United States
  • Brent, Gregory, VA Greater Los Angeles Healthcare, Los Angeles, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Nguyen, Danh V., University of California, Irvine, Orange, California, United States
Background

Diabetic patients are at heightened risk of infection due to the immune dysfunction (i.e., impaired neutrophil function, antioxidant system, and humoral immunity) ensuing from hyperglycemia. While infections are the second leading cause of death in end-stage renal disease patients, little is known about the relationship between average glucose control defined by hemoglobin A1c (HbA1c) and infection risk in the dialysis population.

Methods

Among 642 dialysis patients from the national Biospecimen Registry Grant Program (BioReG) who underwent HbA1c testing over 1/2008-12/2014, we examined the relationship between average glucose control, as reflected in the HbA1c, and risk of bacteremia using case-mix adjusted Poisson regression models adjusted for age, sex, and race/ethnicity.

Results

In the overall cohort, the mean±SD and minimum-maximum HbA1c values were 6.7±1.5% and 3.8-16.0%, respectively; approximately 16% of patients experienced one or more bacteremia events during the follow-up period. Compared to a HbA1c level 6-<7%, patients with HbA1c levels ≥7% had a higher incident rate of bacteremia in case-mix models: adjusted IRRs [aIRRs] 1.11 (0.51-2.41), 1.38 (0.89-2.16), and 1.79 (1.18-2.71) for HbA1c levels <5, 5-<6, and ≥7%, respectively.

Conclusion

Higher HbA1c levels were associated with higher incident rates of bacteremia in dialysis patients. While clinical practice guidelines advise against tight glycemic control in diabetic ESRD patients due to risk of hypoglycemia, liberal glycemic status may also contribute to adverse outcomes due to heightened infection risk. Further studies are needed to more granularly define the upper threshold for heightened infection risk within specific populations.