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Abstract: SA-PO558

The Target Glycated Albumin Level May Differ According to Dialysis Patients' Nutritional Status and Use of Hypoglycemic Agents: A 3-Year Nationwide Cohort Study

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Hoshino, Junichi, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Abe, Masanori, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Hamano, Takayuki, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Hasegawa, Takeshi, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Wada, Atsushi, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Ubara, Yoshifumi, Toranomon Hospital , Tokyo, Japan
  • Takaichi, Kenmei, Toranomon Hospital , Tokyo, Japan
  • Nakai, Shigeru, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Masakane, Ikuto, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Nitta, Kosaku, The Japanese Society for Dialysis Therapy, Tokyo, Japan

Group or Team Name

  • JSDT Renal Data Registry Committee
Background

We previously reported a J-shaped association between glycated albumin (GA) and mortality in diabetic patients on dialysis. However, it remains unclear what GA level is associated with the cause-specific mortality among patients taking or not taking hypoglycemic agents and among those with or without malnutrition.

Methods

We examined 40,417 diabetic patients on maintenance hemodialysis in a cohort studied by the Japanese Society for Dialysis Therapy (female, 30.8%; mean age, 67.3±11.2 years; mean dialysis duration, 5.4±4.6 years) and followed up for 3 years from 2013-2016. GLIM criteria were used to assess malnutrition. Patients on PD, who had history of kidney transplantation, or who did not have data of baseline GA or hypoglycemic agent use were excluded. We used Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence limits (95% CL) for 3-year mortality after adjusting for 18 potential confounders. Subdistribution hazard ratios (SHRs) were used to explore cause-specific mortality.

Results

Using GA levels of 15.9–17.2% as the reference, patients not taking hypoglycemic agents in the lowest GA deciles (≤15.8%) had slightly worse mortality (HR 1.10 [0.94–1.30]), mainly due to increased deaths from cancer (SHR 1.64 [0.99–2.68]), which was not observed in those patients taking hypoglycemic agents. Malnourished patients taking hypoglycemic agents in the lowest GA deciles had slightly worse mortality (HR 1.05 [0.75–1.46]), mainly due to increased deaths due to infections (SHR 1.31 [0.70–2.44]). In addition, their lowest mortality was observed at a GA level of around 21.5%, which was higher than that seen in other patients.

Conclusion

These data suggests that GA levels may differ according to patients’ hypoglycemic agent use, nutritional status, and cancer status. Target GA levels in malnourished patients may be higher than in other diabetic patients, and a very low GA level in dialysis patients not taking hypoglycemic agents may be associated with an increased risk of cancer.

Funding

  • Private Foundation Support