未控制的糖尿病是终末期肾病血液透析患者截肢的有力预测指标。
Uncontrolled Diabetes is a Strong Predictor of Amputation in End Stage Renal Disease Patients on Hemodialysis.
作者信息
Tarricone Arthur, Gee Allen, Boulton Andrew J, Rogers Lee, Lavery Lawrence A
机构信息
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL.
出版信息
Ann Vasc Surg. 2025 May;114:313-319. doi: 10.1016/j.avsg.2024.12.057. Epub 2024 Dec 28.
BACKGROUND
Diabetic nephropathy remains a strong risk factor for chronic kidney disease progression. Hemoglobin A1C (HBA1C) has historically been used as a marker for complications related to diabetes. The purpose of this study is to examine the relationship between HBA1C and clinical complications in a patient population with end stage renal disease.
METHODS
This was a prospective study performed using patients from multiple outpatient dialysis centers in Texas, United States. All patients included patients must have end stage renal disease and were receiving either hemodialysis or peritoneal dialysis. An HBA1C ≥ 6.5% was used as a cutoff to differentiate patients with well controlled versus uncontrolled diabetes in this population.
RESULTS
HBA1C ≥ 6.5% was strongly associated with both minor (P = 0.0014) and major (P = 0.006)amputation. Patients with HBA1C ≥ 6.5% was associated with lower mortality compared to patients with HBA1C < 6.5%, P = 0.007.
CONCLUSION
HBA1C remains a reliable marker for amputation in patients with end-stage renal disease; however, there is skepticism in using HBA1C as a marker for survival in these patients.
背景
糖尿病肾病仍然是慢性肾脏病进展的一个重要危险因素。糖化血红蛋白（HBA1C）一直以来都被用作糖尿病相关并发症的一个标志物。本研究的目的是在终末期肾病患者群体中探讨HBA1C与临床并发症之间的关系。
方法
这是一项前瞻性研究，使用了来自美国得克萨斯州多个门诊透析中心的患者。纳入的所有患者均必须患有终末期肾病且正在接受血液透析或腹膜透析。在该群体中，以HBA1C≥6.5%作为区分糖尿病控制良好与控制不佳患者的临界值。
结果
HBA1C≥6.5%与小截肢（P = 0.0014）和大截肢（P = 0.006）均密切相关。与HBA1C<6.5%的患者相比，HBA1C≥6.5%的患者死亡率更低，P = 0.007。
结论
HBA1C仍然是终末期肾病患者截肢的一个可靠标志物；然而，对于将HBA1C用作这些患者生存的标志物存在质疑。
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