Lin Yi-Chun, Lin Yen-Chung, Chen Hsi-Hsien, Chen Tzen-Wen, Hsu Chih-Cheng, Wu Mai-Szu
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Kidney Int Rep. 2016 Sep 9;2(1):18-26. doi: 10.1016/j.ekir.2016.08.020. eCollection 2017 Jan.
Diabetic kidney disease is an increasingly frequent cause of end-stage renal disease. However, mixed results were shown between glycated hemoglobin and mortality.
We used the average fasting plasma glucose (FPG) levels to predict mortality rates in long-term hemodialysis patients. We enrolled 46,332 hemodialysis patients with diabetes mellitus, who were registered in the Taiwan Renal Registry Data System between January 2005 and December 2012. The patients were stratified based on the quartiles of average FPG levels measured for the first (1-year FPG) and third years (3-year FPG) of hemodialysis. Survival analysis was conducted via multivariable Cox regression.
After the first year of hemodialysis, the mean FPG levels were 103.5 ± 14.5, 144.7 ± 11.5, 189.6 ± 15.2, and 280.8 ± 1.2 mg/dl for the first, second, third, and fourth quartile, respectively. The Kaplan-Meier curve showed an incremental reduction in the survival as FPG levels increased ( < 0.0001). In the Cox regression model, the adjusted hazard ratios were 1.15 (95% CI: 1.10-1.20), 1.30 (95% CI: 1.25-1.36), and 1.45 (95% CI: 1.39-1.51) for the pairwise comparisons between the first quartile and the second, third, and fourth quartile, respectively. Similar trends were observed by 3-year FPG. Patients whose FPG levels increased had a 22% increased risk (95% CI: 1.16-1.29) for all-cause mortality compared with patients whose FPG levels decreased.
Our results suggest that the average FPG levels are useful predictors of all-cause mortality in dialysis patients. In addition, an increasing trend in average FPG levels indicates poor survival.
糖尿病肾病是终末期肾病日益常见的病因。然而，糖化血红蛋白与死亡率之间的结果不一。
我们使用平均空腹血糖（FPG）水平来预测长期血液透析患者的死亡率。我们纳入了2005年1月至2012年12月期间在台湾肾脏登记数据系统中登记的46332例糖尿病血液透析患者。根据血液透析第一年（1年FPG）和第三年（3年FPG）测量的平均FPG水平四分位数对患者进行分层。通过多变量Cox回归进行生存分析。
血液透析第一年之后，第一、第二、第三和第四四分位数的平均FPG水平分别为103.5±14.5、144.7±11.5、189.6±15.2和280.8±1.2mg/dl。Kaplan-Meier曲线显示，随着FPG水平升高，生存率逐渐降低（<0.0001）。在Cox回归模型中，第一四分位数与第二、第三和第四四分位数的两两比较中，调整后的风险比分别为1.15（95%CI：1.10-1.20）、1.30（95%CI：1.25-1.36）和1.45（95%CI：1.39-1.51）。3年FPG观察到类似趋势。与FPG水平降低的患者相比，FPG水平升高的患者全因死亡率风险增加22%（95%CI：1.16-1.29）。
我们的结果表明，平均FPG水平是透析患者全因死亡率的有用预测指标。此外，平均FPG水平的上升趋势表明生存率较差。
