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Abstract: SA-PO1037

The Impact of Antidiabetic Drugs on Morality in Diabetic Patients Undergoing Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chen, Yi-Ting, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  • Lee, Cheng chia, Chang Gung memorial hospital, Taipei, Taiwan
  • Chang, Chih-Hsiang, Chang Gung Memorial Hospital, Taoyuan, Taiwan
  • Chou, Yu-yun, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background

Diabetes mellitus (DM) is associated with an increased risk of morbidity and mortality in patients undergoing hemodialysis (HD). Insulin and other oral antidiabetic drugs (OAD) are usually long-term given for glycemic control. However, there has been little research that have analyzed the long-term effect of antidiabetic drugs to mortality rate. The aim of this study is to evaluate the impact of use of antidiabetic drugs on the risk of mortality in such patients.

Methods

In this retrospective cohort study, we identified 212 diabetic HD patients who continued using at least one kind of antidiabetic drugs for more than 6 months in Chang Gung Memorial Hospital between November 1, 2009 and November 31, 2016. We excluded patients that had dialysis duration less than 6 months (N=60) and follow-up time less than 6 months (N=9). The final cohort comprised a total of 143 patients. Primary outcome was all-cause mortality. Hazard ratios (HR) were calculated by Cox proportional hazard regression models which were used to adjust for age, gender, laboratory data and different antidiabetic drugs use.

Results

In all 143 patients, mean age was 60.9 ± 12.2 years; 43.4% of patients was male and mean dialytic duration was 45.1 months. 71 patients (49.7%) used insulin for glycemic control, 54 (37.8%) used Sulfonylurea, and 25 (17.5%) used Dipeptidyl peptidase-4 inhibitors. After a median follow-up duration of 39.0 months, 60 patients died. Cox-multivariate analysis revealed only age (HR = 1.04, p =0.001), serum albumin (HR = 0.206, p <0.001), and insulin users (HR = 2.39, p= 0.011) to be independent predictors of mortality. The finding persisted after adjusting for hemoglobin A1c level being treated as both a categorical variable or a continuous variable.

Conclusion

This study demonstrated that compared with non-insulin users, insulin users were associated with a higher risk of mortality in diabetic HD patients, independent of glycemic control.

Cox-multivariate analysis for all-cause mortality
 Hazard ratio(HR)95% Confidence interval(CI)p value
Age1.0401.015-1.0650.001
Albumin0.2060.093-0.461<0.001
Insulin2.3891.223-4.6690.011

Multivariate adjustments were made for gender, dialysis duration, hemoglobin, triglycerides, use of Sulfonylurea, Dipeptidyl peptidase-4 inhibitors, and Hemoglobin A1c level.