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Cardiovascular Events and HbA1C levels in Diabetic, Dialysis Patients

Nov 22, 2013

Glycemic control for diabetic, dialysis patients linked to cardiovascular events…. 

Diabetes has long been linked to increased incidence of cardiovascular disease, especially in those with poorly controlled diabetes. Micro- and macro-vascular damage occurs when blood glucose is not well controlled but do HbA1C levels have much of an impact on those with diabetes who are receiving incidental dialysis?

Newly presented research, presented at the American Society of Nephrology’s Kidney Week 2013 meeting, says yes it does. This South Korean prospective cohort study looked at 907 patients who had Type 1 or Type 2 diabetes and incidental dialysis. The researchers followed these patients for a mean of 15 ± 9.9 months and further analyzed their baseline HbA1C levels, which were separated into 5 groups of A1C ranging from <6% to >9%, as they correlated to major cardiovascular events including death. In the follow-up period, 117 patients were identified as either having a major cardiac event not resulting in death (n=78) or death due to cardiovascular diseases (n=39). Hazard ratios were calculated for each quintile of HbA1C and compared to the patients in the HbA1C 7.0 – 7.9% quintile. Those with an A1C of 8 – 8.9% and A1C>9% showed HR and CI of 2.04 (95% CI, 0.92-4.52; p=0.08), and 2.17 (95% CI, 1.02-4.62; p=0.04), respectively. Further sensitivity analysis also showed that patients with an A1C>9% and a BMI ≥24 kg/m2 or serum albumin levels ≥3.3 g/dL had a statistically higher incidence of the studied outcome (death from CVD or non-fatal major CV event).

This study indicates that poor glycemic control in diabetic dialysis patients may increase their risk of major cardiovascular events by 2 – 3 fold. It is important to remember though that hypoglycemia can also cause detrimental effects on these patients. Future studies need to be completed in order to assess the ideal range of blood glucose control in this population in order to improve morbidity, mortality and quality of life.

Practice Pearls:

  • Poor glycemic control in diabetes patients can result in micro- and macro-vascular damage.
  • New research shows that poor glycemic control (HbA1C >9%) in patients with diabetes receiving incidental dialysis may be associated with poorer outcomes including increased risk of major cardiovascular events, including death.
  • Strict blood glucose control may not be the ideal in diabetic patients receiving hemodialysis due to the risk of hypoglycemia, further studies are required to assess the optimal A1C range in this patient population.

Lee, M. et al. Glycemic Control and Cardiovascular Outcomes in Incident Dialysis Patients with Diabetes. Presented at American Society of Nephrology’s Kidney Week 2013 meeting (ahead of print)