Original Report: Patient-Oriented, Translational Research

Extremes of Glycemic Control (HbA_1c) Increase Hospitalization Risk in Diabetic Hemodialysis Patients in the USA
M.E. Williams^a, E. Lacson, Jr.^b, M. Teng^b, R.M. Hakim^b, J.M. Lazarus<sup>b

a</sup>Renal Unit, Joslin Diabetes Center, Boston, Mass., and
^bFresenius Medical Care, Lexington, Mass., USA

Address of Corresponding Author

Am J Nephrol 2009;29:54-61 (DOI: 10.1159/000151276)

  Key Words

• End-stage renal disease, hospitalization
• Diabetes mellitus
• Glycemic control

  Abstract

Background/Aims: Because the relation between glycemic control and clinical outcomes found in the general diabetic population has not been established in diabetic hemodialysis patients, we evaluated the association between glycemic control and hospitalization risk. Methods: We performed a primary retrospective data analysis on 23,829 hemodialysis patients with diabetes mellitus. Hemoglobin A_1c at baseline and hospitalization events over the subsequent 12 months were analyzed and logistic regression models constructed for unadjusted, case mix-adjusted and case mix plus lab- adjusted data. Models were also constructed for cardiovascular, vascular access and sepsis hospitalizations. Results: Eighty percent had type 2 DM, 5% type 1 and 14% not specified. The groups had similar mean HbA_1c levels, 6.8 ± 1.6%. Among all patients, the mean HbA_1c values were >7% in 35%. The odds ratio of hospitalizations grouped by baseline HbA_1c was significant at extremes of <5% and >11%. Similar relationships were evident for the subset of type 2 DM and in the analysis for hospitalizations due to sepsis. Conclusion: Extremely high and low HbA_1c values are associated with hospitalization risk in diabetic hemodialysis patients. Prospective studies are needed to determine whether meeting recommended HbA_1c targets might improve outcomes without posing additional risks in this population.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

M.E. Williams
Renal Unit, Joslin Diabetes Center, 1 Joslin Place
Boston, MA (USA)
Tel. +1 617 732 2477, Fax +1 617 732 2467, E-Mail mark.williams@joslin.harvard.edu

  Article Information

Received: April 30, 2008
Accepted: May 12, 2008
Published online: August 8, 2008
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 1, Number of References : 46