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Abstract: SA-PO553

Poor Glycemic Control Increases Mortality in Elderly Dialysis Patients with Diabetes: A Nationwide Prospective Cohort in Korea

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Lee, Jangwook, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Lee, Jeonghwan, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Gyeonggido, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Oh, Yun Kyu, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Seoul, Korea (the Republic of)
Background

Glycemic control, defined as glycated hemoglobin (HbA1c), was known to be an important factor for mortality in diabetic end-stage renal disease (ESRD) patients. However, the clinical impacts of glycemic control had not been fully elucidated in the elderly diabetic ESRD patients. We investigated whether glycemic control had clinical impact on all-cause mortality of elderly dialysis patients with diabetes.

Methods

A total of 755 elderly diabetic patients (≥ 65 years) who had a value of HbA1c at the time of cohort enrollment were extracted from a nationwide prospective ESRD cohort in Korea between August 2008 and February 2015. The patients were divided into three groups according to the degree of glycemic control (< 6.5%, 6.5-7.9%, and ≥ 8.0%).

Results

The patients in the highest group of HbA1c (≥ 8.0%) were 132 (17.5%), which were younger, had higher vintages of dialysis, and higher percentage of peritoneal dialysis than the other two groups. Mortality rate was 57.2% during the median follow-up of 56.3 months. Patients with poor glycemic control (≥ 8.0%) had a higher risk of mortality compared with those in the HbA1c < 6.5% (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.06-1.77; P = 0.016). In subgroup analysis by dialysis modality, HbA1c ≥ 8.0% was a risk factor for mortality in the patients on peritoneal dialysis (HR 1.66; 95% CI 1.02-2.70; P = 0.041). Multivariate analysis adjusting for age, sex, comorbidity, dialysis vintage, and dialysis modality verified a significant association between poor glycemic control (≥ 8.0%) and mortality rate in the elderly diabetic ESRD patients (HR 1.53; 95% CI 1.17-2.00; P = 0.002).

Conclusion

Poor glycemic control was significantly associated with mortality in the elderly dialysis patients, which suggests that lowering HbA1c to at least less than 8.0% might decrease mortality rate.

Funding

  • Private Foundation Support