Mfundo Emmanuel Arthur, Marealle Alphonce Ignace, Nyondo Goodluck G, Manguzu Martine A, Buma Deus, Kunambi Peter, Mutagonda Ritah F
Quality Assurance Department, National Health Insurance Fund, Arusha, Tanzania.
Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2025 Feb 10;20(2):e0306357. doi: 10.1371/journal.pone.0306357. eCollection 2025.
Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis.
A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control were considered when glycated hemoglobin (HbA1c) levels were < 6% or > 8%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value < 0.05 was considered statistically significant.
Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c < 6% and 28.33% had HbA1c > 8%. A high risk of HbA1c > 8% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06-4.41) p = 0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02-2.48) p = 0.040). The lower risk of HbA1c < 6% was observed in patients dialyzed using glucose-containing dialysates than those dialyzed with glucose-free dialysate (0.57 (95% CI 0.36-0.87) p = 0.020).
The high prevalence of poor glycemic control among diabetic CKD patients, as revealed by this study, has significant implications. Patients on antidiabetic medication and those with less than three dialysis sessions per week are at a high risk of HbA1c > 8%. Conversely, patients dialyzed using glucose-free dialysates are at a high risk of HbA1c < 6%. Glycemic control in diabetic chronic kidney disease (CKD) patients is a great challenge due to altered glucose homeostasis, gluconeogenesis, tubular glucose reabsorption and inaccuracy of glycemic regulation metrics [1]. Furthermore, changed renal pharmacokinetics of antihyperglycemic agents (AHA), uremic milieu, and dialysis therapy also contribute to this challenge [2]. Based on the severe risk of hyperglycemia and hypoglycemia in patients with diabetic end-stage renal disease (ESRD), glycemic control is of paramount importance.
维持性血液透析的糖尿病慢性肾脏病（CKD）患者血糖控制不佳是一项巨大挑战，会导致发病和死亡风险增加。本研究旨在确定维持性血液透析的糖尿病CKD患者血糖控制不佳的患病率及其决定因素。
2023年3月至6月在坦桑尼亚四个地区的12个透析中心进行了一项横断面研究。研究对象为年龄在18岁以上、接受维持性血液透析三个月或更长时间的糖尿病CKD患者。采用连续抽样技术招募患者，并使用半结构化问卷收集数据。主要结局为糖化血红蛋白（HbA1c）水平<6%或>8%时被视为血糖控制不佳。使用社会科学统计软件包（SPSS）23版进行数据分析。单变量和多变量回归模型用于评估血糖控制不佳的决定因素。p值<0.05被认为具有统计学意义。
在233名登记患者中，血糖控制不佳的总体患病率为55.4%，其中27.0%的患者HbA1c<6%，28.33%的患者HbA1c>8%。在服用抗糖尿病药物的患者（2.16（95%CI：1.06 - 4.41），p = 0.035）和每周透析次数少于3次的患者（1.59（95%CI：1.02 - 2.48），p = 0.040）中观察到HbA1c>8%的高风险。与使用无糖透析液透析的患者相比，使用含糖透析液透析的患者HbA1c<6%的风险较低（0.57（95%CI 0.36 - 0.87），p = 0.020）。
本研究揭示的糖尿病CKD患者血糖控制不佳的高患病率具有重要意义。服用抗糖尿病药物的患者和每周透析次数少于三次的患者HbA1c>8%的风险较高。相反，使用无糖透析液透析的患者HbA1c<6%的风险较高。由于葡萄糖稳态、糖异生、肾小管葡萄糖重吸收改变以及血糖调节指标不准确，糖尿病慢性肾脏病（CKD）患者的血糖控制是一项巨大挑战[1]。此外，降糖药物（AHA）的肾脏药代动力学改变、尿毒症环境和透析治疗也加剧了这一挑战[2]。鉴于糖尿病终末期肾病（ESRD）患者发生高血糖和低血糖的严重风险，血糖控制至关重要。
