Al-Ghamdi Saeed M G, Bieber Brian, AlRukhaimi Mona, AlSahow Ali, Al Salmi Issa, Al Ali Fadwa, Al Aradi Ali, Pecoits-Filho Roberto, Robinson Bruce M, Pisoni Ronald L
Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Kidney Int Rep. 2022 Feb 17;7(5):1093-1102. doi: 10.1016/j.ekir.2022.02.012. eCollection 2022 May.
Diabetes mellitus (DM) is a leading cause of end-stage kidney disease (ESKD). We provide the first description of DM prevalence, related outcomes, and the hemoglobin A1c (HbA1c)/mortality relationship in national hemodialysis (HD) patient samples across the Gulf Cooperation Council (GCC) countries.
We analyzed data from the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) in the GCC (2012-2018, = 2274 HD patients ≥18 years old). Descriptive statistics were calculated, and all-cause mortality was analyzed for patients with DM versus without DM and by HbA1c levels in patients with DM by Cox regression with progressive confounder adjustments.
DM in the GCC ranged from 45% to 74% in patients with HD by country. Patients with DM were 13 years older (59.9 vs. 46.7 years) and had greater body mass index (BMI), shorter median years on dialysis (1.5 vs. 3.0 years), and higher comorbidity burden. In patients with DM, insulin use was 26% to 50% across countries, with variable oral antidiabetic drug use (2%-32%); median HbA1c levels were 6.1% to 7.5% across countries. Patients with DM (vs. without DM) had higher crude death rates (15.6 vs. 6.2 deaths per 100 patient-years, mean follow-up 1.3 years) and adjusted mortality (hazard ratio [HR] = 1.72 [95% CI 1.23-2.39]). In patients with DM, mortality was lowest at HbA1c 6.5% to 7.5%, with mortality particularly elevated at high HbA1c >9% (HR = 2.13 [95% CI 1.10-4.10]).
Patients with DM in the GCC have high comorbidity burden and mortality rates despite a relatively young mean age. In GCC countries, a holistic strategy for improving diabetes care and outcomes for HD patients is needed at the primary, secondary, and tertiary levels.
糖尿病（DM）是终末期肾病（ESKD）的主要病因。我们首次描述了海湾合作委员会（GCC）国家全国血液透析（HD）患者样本中糖尿病的患病率、相关结局以及糖化血红蛋白（HbA1c）/死亡率之间的关系。
我们分析了海湾合作委员会前瞻性透析结局和实践模式研究（DOPPS，2012 - 2018年，n = 2274名≥18岁的HD患者）的数据。计算了描述性统计数据，并通过逐步调整混杂因素的Cox回归分析了糖尿病患者与非糖尿病患者的全因死亡率以及糖尿病患者按HbA1c水平分层的死亡率。
按国家划分，海湾合作委员会HD患者中糖尿病患病率在45%至74%之间。糖尿病患者年龄大13岁（59.9岁对46.7岁），体重指数（BMI）更高，透析中位年限更短（1.5年对3.0年），合并症负担更重。在糖尿病患者中，各国胰岛素使用率为26%至50%，口服降糖药使用情况各异（2% - 32%）；各国糖化血红蛋白中位水平为6.1%至7.5%。糖尿病患者（与非糖尿病患者相比）粗死亡率更高（每100患者年15.6例死亡对6.2例死亡，平均随访1.3年）且调整后死亡率更高（风险比[HR] = 1.72 [95% CI 1.23 - 2.39]）。在糖尿病患者中，糖化血红蛋白水平在6.5%至7.5%时死亡率最低，糖化血红蛋白水平>9%时死亡率尤其升高（HR = 2.13 [95% CI 1.10 - 4.10]）。
海湾合作委员会的糖尿病患者尽管平均年龄相对年轻，但合并症负担和死亡率较高。在海湾合作委员会国家，需要在初级、二级和三级层面制定一项改善血液透析患者糖尿病护理和结局的整体策略。
