| Stringent glycaemic control prolongs survival in diabetic patients with end-stage renal disease on haemodialysis. | |
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MedLine Citation:
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PMID: 20883284 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: No suitable index or optimal target for diabetic control has been established for diabetic patients with end-stage renal disease (ESRD) undergoing haemodialysis. To address these issues, the single-centre observational study was conducted. METHODS: Two hundred and forty-five diabetic ESRD patients (23.3% female; age at initiation of haemodialysis 61.7 ± 10.7 years) at start of haemodialysis between 1 January 1995 and 31 December 2004 were enrolled. Subjects were grouped according to glycaemic control level throughout the observational period as follows: mean postprandial plasma glucose (PPG) <8.9 mmol/L, 8.9 mmol/L ≤ PPG < 10.0 mmol/L, 10.0 mmol/L ≤ PPG < 11.1 mmol/L, 11.1 mmol/L ≤ PPG < 12.2 mmol/L and PPG ≥ 12.2 mmol/L; and HbA1c < 6.0%, 6.0-6.4%, 6.5-6.9% and ≥ 7.0%. Survival was then followed until 31 December 2005. RESULTS: Cumulative survival of groups of 10.0 mmol/L ≤ PPG < 11.1 mmol/L, 11.1 ≤ PPG < 12.2 and PPG ≥ 12.2 mmol/L was significantly lower than that for PPG < 8.9 mmol/L as determined by Kaplan-Meier estimation (P = 0.016, 0.009 and 0.031, respectively; log-rank test). In both uni- and multivariate Cox proportional hazard models, mortality hazard ratios were significantly higher for PPG ≥ 10.0 mmol/L than for PPG < 8.9 mmol/L (P = 0.002-0.021). Kaplan-Meier survival curves grouped by HbA1c levels showed no correlation between HbA1c and survival during the observational period. No significant difference in mortality hazard ratios was seen for any HbA1c groups evaluated by Cox proportional hazard model. CONCLUSION: Intensive management of diabetic control at a stringent mean on-study PPG < 10.0 mmol/L will improve the life expectancy in diabetic dialysis patients. However, no range of HbA1c values obtained in this study showed any clear difference in clinical outcomes. |
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Authors:
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Kenji Shima; Machiko Komatsu; Kazuhiko Kawahara; Jun Minaguchi; Shu Kawashima |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Nephrology (Carlton, Vic.) Volume: 15 ISSN: 1440-1797 ISO Abbreviation: Nephrology (Carlton) Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-10-04 Completed Date: 2011-02-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9615568 Medline TA: Nephrology (Carlton) Country: Australia |
Other Details:
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Languages: eng Pagination: 632-8 Citation Subset: IM |
Copyright Information:
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© 2010 The Authors. Nephrology © 2010 Asian Pacific Society of Nephrology. |
Affiliation:
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Department of Medicine, Kawashima Hospital, Tokushima, Japan. skenji@mb.pikara.ne.jp |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers / blood Blood Glucose / drug effects*, metabolism Diabetes Mellitus / blood, drug therapy*, mortality Diabetic Nephropathies / etiology, mortality, therapy* Female Hemoglobin A, Glycosylated / metabolism Humans Hypoglycemic Agents / therapeutic use* Japan Kaplan-Meier Estimate Kidney Failure, Chronic / etiology, mortality, therapy* Male Middle Aged Postprandial Period Proportional Hazards Models Renal Dialysis* Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Blood Glucose; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/hemoglobin A1c protein, human |
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