Abstract: SA-PO325
Glycemic Variability of Hemoglobin A1c-Based Metrics and Mortality in Patients with ESKD Undergoing Dialysis
Session Information
- Diabetic Kidney Disease: Clinical Pathology, Diagnostic and Treatment Advances
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Navarrete, Jose E., Emory University, Atlanta, Georgia, United States
- Guevara, Jose, Universidad de Especialidades Espiritu Santo, Samborondon, Guayas, Ecuador
- Hernandez, Lucas, Emory University, Atlanta, Georgia, United States
- Umpierrez, Guillermo, Emory University, Atlanta, Georgia, United States
Background
HbA1c has long been recommended as the gold standard for assessing glycemic control in patients with diabetes. However, the correlation between glycemic control by HbA1c and outcomes is less than optimal in end-stage kidney disease (ESKD). HbA1c variability has been proposed as a better tool to predict outcomes, including mortality in ESKD. We report the predictive value of HbA1c variability on all-cause mortality in patients undergoing dialysis
Methods
Patients with diabetes new to dialysis, enrolled in an academic dialysis program from 1/2010 to 12/2023. HbA1c was measured quarterly. Patients with at least 90 days on dialysis and 3 consecutive measures of HbA1c were included. The coefficient of variation (CV, standard deviation divided by mean HbA1c) and variability index (VI, change of 0.5% compared to previous value) were used as predictors of mortality. The association between CV, VI and mortality was assessed using Cox models, with CV and VI values as continued variables and tertile of distribution (Figure). Adjustments for age, body mass index (BMI), history of heart failure, and peripheral vascular disease were included in all models
Results
979 patients were eligible, 91.5% with type 2 diabetes. The median age was 60.5 years (IQR: 50.8-68.7), 52.5% males, 89.2% African-Americans, BMI 27.6 kg/m2, and median follow-up of 3.3 years (IQR: 1.9-5.6). Glycemic variability indices- CV (p<0.001) and VI (p<0.01) were significantly associated with mortality. Their highest tertile- CV (HR 1.42, CI: 1.10-1.83) and VI (HR 1.44, CI: 1.12-1.85) were also associated with higher mortality compared to the lowest tertile
Conclusion
Glycemic variability of HbA1C - coefficient of variation and variability index- were strongly associated with all-cause mortality in ESKD undergoing dialysis