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 A1c (HbA1c) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA1c < 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 (HbA1c <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 (HbA1c ≥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 language | English |
|---|---|
| Article number | e3118 |
| Journal | Medicine (United States) |
| Volume | 95 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 2016 Jan 1 |
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All Science Journal Classification (ASJC) codes
- Medicine(all)
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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, Seung Hyeok; Yoo, Tae Hyun; 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 journal › Article
TY - JOUR
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, Seung Hyeok
AU - Yoo, Tae Hyun
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 A1c (HbA1c) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA1c < 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 (HbA1c <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 (HbA1c ≥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 A1c (HbA1c) and dialysis modalities for patient survival (P for interaction =0.004), subjects were stratified into good and poor glycemic control groups (HbA1c < 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 (HbA1c <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 (HbA1c ≥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.
UR - http://www.scopus.com/inward/record.url?scp=84961999713&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84961999713&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000003118
DO - 10.1097/MD.0000000000003118
M3 - Article
C2 - 26986162
AN - SCOPUS:84961999713
VL - 95
JO - Medicine (United States)
JF - Medicine (United States)
SN - 0025-7974
IS - 11
M1 - e3118
ER -