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Kidney Week

Abstract: SA-PO455

Higher Glycemic Variability Increased the Risk of All-Cause Mortality in Patients with Diabetes Mellitus on Hemodialysis

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Matei, Bogdan Sorin, Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
  • Nasic, Salmir, Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  • Peters, Björn, Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  • Wärme, Anna, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Svensson, Johan, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Afghahi, Hanri, Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
Background

Glycemic (HbA1c) variability has been recognized as an important predictor for the risk of cardiovascular events and all-cause mortality in patients with diabetes mellitus (DM) with and without renal failure.The aim of this study was to examine the association between HbA1c variability, as a measure of long-term glycemic control and the risk of all-cause mortality in patients with DM and HD.

Methods

Data of 2061 patients (collected between 2008 and 2018) with DM type 1 and 2 and HD were analyzed. HbA1c variability before and after HD was defined as the coefficient variation (CV), which was calculated as the ratio between the standard deviation (SD) and the mean of HbA1c. The relationships between HbA1c variability and mortality were examined by Cox models to estimate hazard ratios (HR) with and 95% confidence intervals (CI) in univariate and multivariate analyses, which was adjusted for demographics, laboratory findings and comorbidity. The patients were divided in seven groups, and we used the lowest CV group (CV≤0.5) as the reference group.

Results

During follow-up, 1071 (52%) deaths occurred. Through entire time of study each one unit increase of CV was associated with higher risk of mortality (HR 1.11, CI 1.02-1.23). Data before HD-start showed that 969 (47%) patients had HbA1c variability with CV>1, which increased to 1188 (58%) during HD. Patients in the group with the lowest CV≤0.5 had the best survival and 169 (8%) of these patients died. In a sub-analysis before HD-start, 597 (29%) of the patients had CV≤0.5, but during HD, 405 (20%) of the patients had CV≤0.5. The two groups with highest CV>2.8 had the highest risk of mortality and 305 (15%) of these patients died. In a sub-analysis before HD-start, 268 (13%) of the patients had CV>2.8, but during HD, 449 (22%) of the patients had CV>2.8.In the multivariate Cox analyses, the groups with highest CV (2.8-4.6 and >4.6) were associated with increased risk of mortality (HR 1.98, CI 1.54-2.47 and HR 1.99, CI 1.54-2.57) compared with the reference group.

Conclusion

Glycemic variability should be considered an important risk factor for mortality in patients with DM and HD. In patients with DM andHD, we highly recommend consistent monitoring of glucose homeostasis and regular evaluation of DM treatment.