Correlates of low hemoglobin A1c in maintenance hemodialysis patients
International Urology and Nephrology, 06/12/2012
Kim Y et al. – In diabetic maintenance hemodialysis (MHD) patients with burnt–out diabetes, characterized by HbA1c <6 %, even lower HbA1c levels are associated with significantly higher death risk. Additional studies are needed to determine the optimal target for HbA1c levels in different subgroups of diabetic MHD patients.Methods
- A 6-year cohort (October 2001– December 2006) of 347 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality.
- Death hazard ratios (HR) were estimated using Cox regressions and cubic splines.
- In these 347 patients (age, 59±11years; 49 % women; 28 % African Americans; and 55 % Hispanics), each 0.5 % decline in HbA1c below 6 % was associated with a 4.7 times higher death risk (HR=4.7; 95 % CI 1.7–12.7) in the fully adjusted model.
- Factors associated with lower HbA1c levels (<6 % compared to 6–7 %) were: Hispanic ethnicity (OR=2.9; 95 % CI 1.1–7.9), higher mid-arm muscle circumstance (OR=1.1; 95 % CI 1.0–1.3), higher total iron-binding capacity (OR=1.03; 95 % CI 1.01–1.05), and higher iron saturation ratio (OR=1.14; 95 % CI 1.03–1.26).
- HbA1c levels >7 % showed a consistent trend toward elevated mortality risk (HR=1.18; 95 % CI 0.99–1.41) after multivariate adjustment.