Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Diabetes Res Clin Pract. 2022 Aug;190:110016. doi: 10.1016/j.diabres.2022.110016. Epub 2022 Jul 21.
Adequate glycemic control is fundamental for improving clinical outcomes in hemodialysis patients with diabetes. However, the target for glycated hemoglobin (HbA1c) level and whether cause-specific mortality differs based on HbA1c levels remain unclear.
A total of 24,243 HD patients with diabetes were enrolled from a multicenter, nationwide registry. We examined the association between HbA1c levels and the risk of all-cause and cause-specific mortality.
Compared to patients with HbA1c 6.5%-7.5%, patients with HbA 8.5-9.5% and ≥9.5% were associated with a 1.26-fold (95% CI, 1.12-1.42) and 1.56-fold (95% CI, 1.37-1.77) risk for all-cause mortality. The risk of all-cause mortality did not increase in patients with HbA1c < 5.5%. In cause-specific mortality, the risk of cardiovascular deaths significantly increased from small increase of HbA1c levels. However, the risk of other causes of death increased only in patients with HbA1c > 9.5%. The slope of HR increase with increasing HbA1c levels was significantly faster for cardiovascular causes than for other causes.
There was a linear relationship between HbA1c levels and risk of all-cause mortality in hemodialysis patients, and the risk of cardiovascular death increased earlier and more rapidly, with increasing HbA1c levels, compared with other causes of death.
对于合并糖尿病的血液透析患者，血糖控制达标对于改善临床结局至关重要。然而，糖化血红蛋白（HbA1c）的目标水平以及死亡率是否因 HbA1c 水平而异仍不清楚。
这项多中心、全国性注册研究共纳入 24243 名合并糖尿病的血液透析患者。我们检验了 HbA1c 水平与全因和特定原因死亡率风险之间的关联。
与 HbA1c 水平为 6.5%-7.5%的患者相比，HbA1c 水平为 8.5-9.5%和≥9.5%的患者发生全因死亡率的风险分别增加 1.26 倍（95%CI：1.12-1.42）和 1.56 倍（95%CI：1.37-1.77）。HbA1c＜5.5%的患者全因死亡率风险并未增加。在特定原因死亡率方面，心血管死亡风险随着 HbA1c 水平的轻微升高而显著增加。然而，其他原因死亡的风险仅在 HbA1c＞9.5%的患者中增加。随着 HbA1c 水平的升高，HR 增加的斜率对于心血管原因的死亡明显快于其他原因。
在血液透析患者中，HbA1c 水平与全因死亡率风险之间存在线性关系，与其他原因死亡相比，心血管死亡的风险随着 HbA1c 水平的升高更早且更快地增加。
