Department of Nephrology, Skaraborg Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Research and Development Centre at Skaraborg Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Diabetes Res Clin Pract. 2022 Sep;191:110033. doi: 10.1016/j.diabres.2022.110033. Epub 2022 Aug 6.
Knowledge about association between glycated hemoglobin (HbA1c) and risk of all-cause mortality in patients with diabetes mellitus on maintenance hemodialysis (HD)-treatment is sparse. The study aims to investigate association between HbA1c and all-cause mortality in patients with diabetes and maintenance HD-treatment, separately for two age groups- above and below 75 years.
2487 patients (mean age 66 years, 66 % men) were separated in two age groups: ≤75 years (n = 1810) and > 75 years (n = 677) and followed up between 2008 and 2018. Hazard ratios (HR) and 95 % confidence intervals (CI) for associations between HbA1c and all-cause mortality were calculated using Cox-regression-models.
1295 (52 %) patients died and 473 (70 %) among the patients above 75 years old. In the multivariate analysis, HbA1c5-6 % was used as reference. In patients ≤ 75 years old, only increased HbA1c > 9.7 %, HR2.03(CI1.43-2.89) was associated with increased risk of all-cause mortality. In patients > 75 years, HbA1c ≤ 5 %, HR1.67(CI1.16-2.40); HbA1c6.9-7.8 %, HR1.41(CI1.03-1.93) and HbA1c8.7-9.7 %, HR1.79 (CI1.08-2.96) were associated with increased risk of all-cause mortality.
We found a J-shaped association between HbA1c and mortality only in diabetic HD-patients > 75 years. This probably indicates that in an old population of diabetic HD-patients, both intensive glucose control and hyperglycemia could be harmful and associated with higher risk of death.
糖化血红蛋白（HbA1c）与接受维持性血液透析（HD）治疗的糖尿病患者全因死亡率之间的关联知之甚少。本研究旨在分别探讨年龄>75 岁和≤75 岁的糖尿病合并维持性 HD 治疗患者的 HbA1c 与全因死亡率之间的关系。
将 2487 例患者（平均年龄 66 岁，66%为男性）分为两组：年龄≤75 岁（n=1810）和年龄>75 岁（n=677），随访时间为 2008 年至 2018 年。使用 Cox 回归模型计算 HbA1c 与全因死亡率之间的关联的风险比（HR）和 95%置信区间（CI）。
1295 例（52%）患者死亡，其中 473 例（70%）患者年龄>75 岁。多变量分析中，HbA1c5-6%作为参考。在年龄≤75 岁的患者中，仅 HbA1c>9.7%与全因死亡率增加相关（HR2.03[1.43-2.89]）。在年龄>75 岁的患者中，HbA1c≤5%（HR1.67[1.16-2.40]）、HbA1c6.9-7.8%（HR1.41[1.03-1.93]）和 HbA1c8.7-9.7%（HR1.79[1.08-2.96]）与全因死亡率增加相关。
我们发现仅在年龄>75 岁的糖尿病合并 HD 患者中，HbA1c 与死亡率之间存在 J 形关联。这可能表明，在老年糖尿病 HD 患者人群中，强化血糖控制和高血糖都可能有害，并与更高的死亡风险相关。
