Glycemic control modifies difference in mortality risk between hemodialysis and peritoneal dialysis in incident dialysis patients with diabetes

Results from a nationwide prospective cohort in Korea

Mi Jung Lee, Young Eun Kwon, Kyoung Sook Park, Youn Kyung Kee, Chang Yun Yoon, In Mee Han, Seung Gyu Han, Hyung Jung Oh, Jung Tak Park, SeungHyeok Han, TaeHyun Yoo, Yong Lim Kim, Yon Su Kim, Chul Woo Yang, Nam Ho Kim, Shin-Wook Kang

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A 1c (HbA 1c ) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA 1c < or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR]=0.65, 95% confidence interval [CI]=0.47-0.90, P=0.01; patients with available HbA1c [n=773], HR=0.64, 95% CI=0.46-0.91, P=0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA 1c <8.0%, HR=0.59, 95% CI=0.37- 0.94, P=0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA 1c ≥8.0%, HR=1.21, 95% CI=0.46-2.76, P=0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.

Original languageEnglish
Article numbere3118
JournalMedicine (United States)
Volume95
Issue number11
DOIs
Publication statusPublished - 2016 Jan 1

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Peritoneal Dialysis
Korea
Renal Dialysis
Dialysis
Hemoglobin A
Mortality
Confidence Intervals
Control Groups
Survival
Survival Rate
Propensity Score
Chronic Kidney Failure

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lee, Mi Jung ; Kwon, Young Eun ; Park, Kyoung Sook ; Kee, Youn Kyung ; Yoon, Chang Yun ; Han, In Mee ; Han, Seung Gyu ; Oh, Hyung Jung ; Park, Jung Tak ; Han, SeungHyeok ; Yoo, TaeHyun ; Kim, Yong Lim ; Kim, Yon Su ; Yang, Chul Woo ; Kim, Nam Ho ; Kang, Shin-Wook. / Glycemic control modifies difference in mortality risk between hemodialysis and peritoneal dialysis in incident dialysis patients with diabetes : Results from a nationwide prospective cohort in Korea. In: Medicine (United States). 2016 ; Vol. 95, No. 11.
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title = "Glycemic control modifies difference in mortality risk between hemodialysis and peritoneal dialysis in incident dialysis patients with diabetes: Results from a nationwide prospective cohort in Korea",
abstract = "Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A 1c (HbA 1c ) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA 1c < or ≥8.0{\%}). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR]=0.65, 95{\%} confidence interval [CI]=0.47-0.90, P=0.01; patients with available HbA1c [n=773], HR=0.64, 95{\%} CI=0.46-0.91, P=0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA 1c <8.0{\%}, HR=0.59, 95{\%} CI=0.37- 0.94, P=0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA 1c ≥8.0{\%}, HR=1.21, 95{\%} CI=0.46-2.76, P=0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.",
author = "Lee, {Mi Jung} and Kwon, {Young Eun} and Park, {Kyoung Sook} and Kee, {Youn Kyung} and Yoon, {Chang Yun} and Han, {In Mee} and Han, {Seung Gyu} and Oh, {Hyung Jung} and Park, {Jung Tak} and SeungHyeok Han and TaeHyun Yoo and Kim, {Yong Lim} and Kim, {Yon Su} and Yang, {Chul Woo} and Kim, {Nam Ho} and Shin-Wook Kang",
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Glycemic control modifies difference in mortality risk between hemodialysis and peritoneal dialysis in incident dialysis patients with diabetes : Results from a nationwide prospective cohort in Korea. / Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, SeungHyeok; Yoo, TaeHyun; Kim, Yong Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam Ho; Kang, Shin-Wook.

In: Medicine (United States), Vol. 95, No. 11, e3118, 01.01.2016.

Research output: Contribution to journalArticle

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T1 - Glycemic control modifies difference in mortality risk between hemodialysis and peritoneal dialysis in incident dialysis patients with diabetes

T2 - Results from a nationwide prospective cohort in Korea

AU - Lee, Mi Jung

AU - Kwon, Young Eun

AU - Park, Kyoung Sook

AU - Kee, Youn Kyung

AU - Yoon, Chang Yun

AU - Han, In Mee

AU - Han, Seung Gyu

AU - Oh, Hyung Jung

AU - Park, Jung Tak

AU - Han, SeungHyeok

AU - Yoo, TaeHyun

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kang, Shin-Wook

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A 1c (HbA 1c ) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA 1c < or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR]=0.65, 95% confidence interval [CI]=0.47-0.90, P=0.01; patients with available HbA1c [n=773], HR=0.64, 95% CI=0.46-0.91, P=0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA 1c <8.0%, HR=0.59, 95% CI=0.37- 0.94, P=0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA 1c ≥8.0%, HR=1.21, 95% CI=0.46-2.76, P=0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.

AB - Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A 1c (HbA 1c ) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA 1c < or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR]=0.65, 95% confidence interval [CI]=0.47-0.90, P=0.01; patients with available HbA1c [n=773], HR=0.64, 95% CI=0.46-0.91, P=0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA 1c <8.0%, HR=0.59, 95% CI=0.37- 0.94, P=0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA 1c ≥8.0%, HR=1.21, 95% CI=0.46-2.76, P=0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes.

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