Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study
Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study
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DOI：
10.1007/s00125-007-0650-z
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发表时间：
2007-06-01
期刊：
影响因子：
8.2
通讯作者：
Kurokawa, K.
中科院分区：
文献类型：
--
作者：
Hayashino, Y.;Fukuhara, S.;Kurokawa, K.
目的/假设 关于血液透析糖尿病患者血糖控制目标水平的数据很少。我们调查了血糖控制对接受血液透析的糖尿病患者死亡风险的影响。 对象和方法 对日本随机选择的接受血液透析的患者进行的透析结果实践模式研究 (DOPPS) 中的数据进行了分析。从病历中提取基线糖尿病诊断和随访期间临床事件信息。使用 Cox 比例风险模型评估是否存在糖尿病、血糖控制（HbA(1c) 五分位数）和死亡风险之间的关联。 结果 对 1,569 名接受血液透析的糖尿病患者和 3,342 名非糖尿病患者的数据进行了分析。在接受血液透析的患者中，糖尿病患者的死亡风险高于未接受血液透析的患者（多变量风险比 1.37，95% CI 1.08-1.74）。与 HbA(1c) 水平底部五分位数的患者相比，HbA(1c) 底部第二至第四五分位数的多变量调整死亡风险比没有增加（HbA(1c) 5.0-5.5% 至 6.2-7.2%），但在第五个五分位数中显着增加至 2.36 (95% CI 1.02-5.47) （糖化血红蛋白 (1c)>= 7.3%）。血糖控制不佳的影响与基线死亡风险没有统计学相关性（p=0.27）。结论/解释在透析患者中，糖尿病患者的血糖控制较差与较高的死亡风险相关。这表明，HbA(1c) 水平高于约 7.3% 时，血糖控制不佳对死亡风险有很强的影响，而且这种影响似乎不受基线合并症状态的影响。
Aims/hypothesis There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis.Subjects and methods Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan. The diagnosis of diabetes at baseline and information on clinical events during follow-up were abstracted from the medical records. A Cox proportional hazards model was used to evaluate the association between presence or absence of diabetes, glycaemic control (HbA(1c) quintiles) and mortality risk.Results Data from 1,569 patients with and 3,342 patients without diabetes on haemodialysis were analysed. Among patients on haemodialysis, those with diabetes had a higher mortality risk than those without (multivariable hazard ratio 1.37, 95% CI 1.08-1.74). Compared with those in the bottom quintile of HbA(1c) level, the multivariable-adjusted hazard ratio for mortality was not increased in the bottom second to fourth quintiles of HbA(1c) (HbA(1c) 5.0-5.5% to 6.2-7.2%), but was significantly increased to 2.36 (95% CI 1.02-5.47) in the fifth quintile (HbA(1c)>= 7.3%). The effect of poor glycaemic control did not statistically correlate with baseline mortality risk (p=0.27).Conclusions/interpretation Among dialysis patients, poorer glycaemic control in those with diabetes was associated with higher mortality risk. This suggests a strong effect of poor glycaemic control above an HbA(1c) level of about 7.3% on mortality risk, and that this effect does not appear to be influenced by baseline comorbidity status.