Higher Glucose Levels At Dialysis Transition Increase Mortality Risk

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Patients with kidney failure who have high glucose levels when they transition to dialysis are at increased risk of death.
Patients with kidney failure who have high glucose levels when they transition to dialysis are at increased risk of death.

Higher glucose levels in diabetic patients with advanced chronic kidney disease (CKD) who transitioned to dialysis were associated with increased mortality following dialysis initiation, according to a new study.

Among diabetic CKD patients who did not transition to dialysis, however, both lower and higher glucose levels were associated with an elevated death risk.

“These data suggest the need for different glycemic strategies based on whether there are plans to transition to dialysis versus pursue conservative management among diabetic patients with CKD,” Connie M. Rhee, MD, MSc, of the University of California Irvine School of Medicine, and colleagues concluded in the Journal of Renal Nutrition.

Among patients with advanced CKD, they noted, the optimal glycemic level “has remained elusive due to a paucity of data that have shown mixed findings in this population.”

Dr Rhee and her collaborators examined the association of glycemic status with mortality in two cohorts of diabetic US Veterans with CKD: 17,121 patients who transitioned to dialysis during the period from 2007 to 2011 who were matched to 8711 patients who did not transition to dialysis on the basis of age, sex, race, and other characteristics (Transition Cohort and Nontransition Cohort, respectively). The Transition Cohort consisted of participants in the Transition of Care in CKD study, and the Nontransition Cohort included patients in the Racial and Cardiovascular Risk Anomalies in CKD cohort.

In the Transition Cohort, averaged random glucose values of ≥200 mg/dL prior to transition to dialysis were significantly associated with a 26% increased risk of death in adjusted analyses compared with a reference range of 100 to <120 mg/dL. HbA1c values of 8% to <10% were associated with a 21% increased risk of death compared with a reference range of 6% to <8%.

In the Nontransition Cohort, average random glucose levels below 100 mg/dL were significantly associated with a 70% increased risk of death; levels of 160 to <180, 180 to <200, and ≥200 mg/dL were significantly associated with 55%, 42%, and 34% increased mortality risks, respectively, in adjusted analyses. HbA1c was not associated with mortality in the Nontransition Cohort.

Reference

Rhee CM, Kovesdy CP, Ravel VA, et al. Glycemic status and mortality in chronic kidney disease according to transition versus nontransition to dialysis. J Ren Nutr. 2019; published online ahead of print.

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