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Abstract: PO0770

Cause-Specific Death Differs Based on HbA1c Levels 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, Seoul, Korea (the Republic of)
  • Kim, Dae Kyu, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Jongho, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kang, Shinyeong, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Kim, Jin sug, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Jeong, Kyung hwan, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Lee, Sangho, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Moon, Ju young, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
  • Hwang, Hyeon Seok, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
Background

Adequate glycemic control with achieving target HbA1c is critical in hemodialysis (HD) patients with diabetes and HbA1c level is closely associated with mortality risk. However, it is unclear whether different HbA1c levels affect mortality risk of cause-specific deaths or not.

Methods

A total 24,620 maintenance HD patients with diabetes were enrolled from the electronic health record-based registry data of Korean Society of Nephrology. Plasma HbA1c level was measured at the time of the study data entry, and patients were classified into six categories according to the HbA1c level (≤5.5%, 5.6-6.5%, 6.6-7.5%, 7.6-8.5%, 8.6%-9.5%, and >9.5%). In multivariable Cox regression analysis, we examined the relationship between HbA1c level and the risk of cause-specific death (cardiovascular, infection, non-cardiovascular/non-infection).

Results

Compared with the group with HbA1c 6.6-7.5%, the risk of all-cause mortality in each group tended to increase as HbA1c level rose; 0.99-fold (95% confidence interval [CI], 0.91-1.07) in HbA1c 5.6-6.5%, 1.08-fold (95% CI, 0.99-1.19) in HbA1c 7.6-8.5%, (95% CI, 0.99-1.19), 1.26-fold in HbA1c 8.6-9.5% (95% CI, 1.12-1.42), and 1.57-fold in HbA1c >9.5% (95% CI, 1.39-1.78). In cause-specific death analysis, cardiovascular-related mortality risk showed similar hazard ratio pattern like all-cause mortality risk and the adjusted risk for each group were 0.96 (95% CI, 0.84-1.09), 1.17 (95% CI, 1.01-1.35), 1.53 (95% CI, 1.29-1.82) and 1.57-fold (95% CI, 1.30-1.91) for HbA1c 5.6-6.5%, HbA1c 7.6-8.5%, HbA1c 8.6-9.5% and HbA1c >9.5%, respectively. However, infection-related mortality risk did not significantly increase across HbA1c strata except the risk in HbA1c >9.5% group (HR, 1.71; 95% CI, 1.29-2.26). Non-cardiovascular related/non-infection related mortality risk did not increase in all six HbA1c categories.

Conclusion

All-cause mortality and cause-specific mortality risk were different according to HbA1c levels in the patients who were undergoing HD with diabetes. Furthermore, this study showed that cardiovascular mortality risk needs to be assessed in priority than infection or non-cardiovascular related/non-infection mortality risk when HbA1c level is increased in HD patients with diabetes.