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Abstract: SA-PO279

Fasting Blood Glucose and the Risk of Cause-Specific Death in Hemodialysis Patients With Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Yoon, Soo-Young, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Lim, Sojin, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Geon Woo, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Kim, Jongho, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Ko, Gang Jee, Korea University College of Medicine and School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Jin sug, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Moon, Ju young, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Dongdaemun-gu, Seoul, Korea (the Republic of)
Background

Glycemic control is fundamental to optimize the care of hemodialysis patients (HD) with diabetes. Most relevant studies focused on hemoglobin A1c values as an representative marker in general population. Therefore, current guidelines could not suggest any clear target of fasting blood glucose (FBG). The aim of the study is to examine the association between FBG and the risk of mortality and to sort out the HD patients who may benefit from strict FBG control.

Methods

Through reviewing the National Health Insurance Database of Korea, a total of 6,605 patients starting HD treatment with diabetes were included between 2002 and 2018. The participants were grouped into six following FBG categories: (1) <80 mg/dL, (2) 80-100 mg/dL, (3) 100-125 mg/dL, (4) 125–150 mg/dL, (5) 150-180 mg/dL, and (6) ≥180 mg/dL. Conventional and time-varying Cox regression models evaluated the association between FBG and all-cause mortality. We conducted baseline covariate-adjusted subsequent subgroup analyses.

Results

In a conventional Cox model compared to patients with FBG 80-100 mg/dL, adjusted hazard ratios (aHR) for all-cause mortality were significantly higher in patients with FBG 100-125 (aHR, 1.21 [95% confidence interval (CI), 1.07-1.36]), 125–150 (aHR, 1.20 [95% CI, 1.05-1.38]), 150-180 (aHR, 1.38 [95% CI, 1.19-1.61]), and ≥180 mg/dL (aHR, 1.46 [95% CI, 1.27-1.68]) except for patients with FBG <80 mg/dL. According to a time-varying Cox regression analysis, the mortality risks increased in participants with FBG <80 (aHR, 1.17 [95% CI, 1.08-1.27]), 100-125 (aHR, 1.08 [95% CI, 1.02-1.15]), 125–150 (aHR, 1.18 [95% CI, 1.10-1.28]), 150-180 (aHR, 1.31 [95% CI, 1.20-1.43]), and ≥180 mg/dL (aHR, 1.30 [95% CI, 1.21-1.39]). Compared with partients grouped into FBG 80-100 mg/dL, patients who were younger than 65, female, belonged to both normal and over body mass index, and low Charlson comorbidity index score were at a relatively higher mortality risk in case of FBG ≥100 mg/dL.

Conclusion

Targeting FBG from 80 to 100 mg/dL significantly alleviated the risk of all-cause mortality in diabetic HD patients when compared to those with FBG <80 mg/dL or ≥ 100 mg/dL. Further research needs to be done to elucidate the target level of FBG to minimize the mortality risk in subgroup of HD patients with diabetes.