Kidney Week

Abstract: TH-PO721

Glycemic Status and Mortality in CKD According to Transition versus Non-Transition to Dialysis

Session Information

• Diabetic and Obesity Induced Kidney Disease - Clinical - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Diabetes

• 502 Diabetes Mellitus and Obesity: Clinical

Authors

• Rhee, Connie, University of California Irvine, Huntington Beach, California, United States

Connie Rhee,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Ravel, Vanessa A., Harold Simmons Center, University of California at Irvine, Orange, California, United States

Vanessa A. Ravel,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Soohoo, Melissa, University of California at Irvine, Orange, California, United States

Melissa Soohoo,

• Brent, Gregory, VA Greater Los Angeles Healthcare, Los Angeles, California, United States

Gregory Brent,

• Nguyen, Danh V., University of California, Irvine, Irvine, California, United States

Danh V. Nguyen,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

The optimal glycemic target in diabetic non-dialysis dependent chronic kidney disease (NDD-CKD) patients remains uncertain, as most trials of glycemic control excluded advanced kidney disease patients. We examined pre-ESRD glycemic status, defined by random blood glucose and hemoglobin A1c (HbA1c), with early post-ESRD mortality among diabetic NDD-CKD patients transitioning to dialysis. In parallel, we examined glycemic status and mortality in a matched cohort of NDD-CKD patients who did not transition to dialysis.

Methods

Among US veterans with diabetic NDD-CKD transitioning to dialysis from 2007-11 (Transition Cohort), we examined 1-year pre-ESRD averaged random glucose and HbA1c with 1-year all-cause mortality using expanded case-mix Cox models. Analogous analyses were conducted among CKD patients who did not transition to dialysis within 1-year (Non-Transition Cohort) matched on the basis of age, sex, race, ethnicity, and baseline CKD stage.

Results

Among 17,121 patients in the Transition Cohort, averaged random glucose ≥200mg/dl was associated with higher mortality (ref: 100-<120mg/dl), and HbA1c ≥8% was associated with higher mortality (reference: 6-<8%). Among 8711 patients in the Non-Transition Cohort, lower glucose <100mg/dl and higher glucose ≥160mg/dl were associated with higher mortality, whereas HbA1c was not associated with death.

Conclusion

In diabetic NDD-CKD patients transitioning to dialysis, higher averaged random glucose and HbA1c were associated with early dialysis mortality. In patients who did not transition, there was a U-shaped association between glucose and mortality. These data suggest liberal glycemic status is associated with long-term mortality risk, whereas intensive glycemic status is associated with short-term risk.

Funding

• NIDDK Support