Glycemic Control and Cardiovascular Mortality in Hemodialysis Patients With Diabetes A 6-Year Cohort Study
Glycemic Control and Cardiovascular Mortality in Hemodialysis Patients With Diabetes A 6-Year Cohort Study
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DOI：
10.2337/db11-1015
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发表时间：
2012-03-01
期刊：
影响因子：
7.7
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Ricks, Joni;Molnar, Mildos Z.;Kalantar-Zadeh, Kamyar
先前使用不同方法的观察性研究在接受维持性血液透析（MHD）的糖尿病患者中血糖控制与结局之间的相关性方面得出了不一致的结果。我们在54，757例糖尿病MHD患者（年龄63 ± 13岁，51%男性，30%非洲裔美国人，19%西班牙裔）的当代队列中研究了A1 C和随机血糖随时间的死亡率预测性。基线A1 C增量为8.0-8.9、9.0-9.9和>= 10%的校正后全因死亡风险比（HR）与7.0-7.9%相比（参考）为1.06（95% CI 1.01-1.12），1.05（0.99-1.12）和1.19（1.12-1.28），时间平均A1 C分别为1.11（1.05-1.16）、1.36（1.27-1.45）和1.59（1.46-1.72）。死亡率的对称增加也发生在时间平均A1 C水平处于低范围的情况下。（6.0- 6.9%，HR 1.05 [95% CI 1.01-1.08]; 5.0- 5.9%，1.08 [1.04-1.11]，且≤ 300 mg/dL，与150-175 mg/dL（参比品）相比，为1.03（95% CI 0.99-1.07）、1.14（1.10-1.19）、1.30（1.23-1.37）和1.66（1.56-1.76）。因此，血糖控制不良（A1 C>= 8%或血糖>= 200 mg/dL）似乎与MHD患者的高全因和心血管死亡相关。极低的血糖水平也与高死亡风险相关。糖尿病61：708-715，2012
Previous observational studies using differing methodologies have yielded inconsistent results regarding the association between glycemic control and outcomes in diabetic patients receiving maintenance hemodialysis (MHD). We examined mortality predictability of A1C and random serum glucose over time in a contemporary cohort of 54,757 diabetic MHD patients (age 63 +/- 13 years, 51% men, 30% African Americans, 19% Hispanics). Adjusted all-cause death hazard ratio (HR) for baseline A1C increments of 8.0-8.9, 9.0-9.9, and >= 10%, compared with 7.0-7.9% (reference), was 1.06 (95% CI 1.01-1.12), 1.05 (0.99-1.12), and 1.19 (1.12-1.28), respectively, and for time-averaged A1C was 1.11 (1.05-1.16), 1.36 (1.27-1.45), and 1.59 (1.46-1.72). A symmetric increase in mortality also occurred with time-averaged A1C levels in the low range (6.0-6.9%, HR 1.05 [95% CI 1.01-1.08]; 5.0-5.9%, 1.08 [1.04-1.11], and = 300 mg/dL, compared with 150-175 mg/dL (reference), was 1.03 (95% CI 0.99-1.07), 1.14 (1.10-1.19), 1.30 (1.23-1.37), and 1.66 (1.56-1.76), respectively. Hence, poor glycemic control (A1C >= 8% or serum glucose >= 200 mg/dL) appears to be associated with high all-cause and cardiovascular death in MHD patients. Very low glycemic levels are also associated with high mortality risk. Diabetes 61:708-715, 2012