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; Seung Hyeok Han; Tae Hyun Yoo; Yong Lim Kim; Yon Su Kim; Chul Woo Yang; Nam Ho Kim; Shin Wook Kang

doi:10.1097/MD.0000000000003118

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, Seung Hyeok Han, Tae Hyun Yoo, Yong Lim Kim, Yon Su Kim, Chul Woo Yang, Nam Ho Kim, Shin Wook Kang

Department of Internal Medicine

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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 language	English
Article number	e3118
Journal	Medicine (United States)
Volume	95
Issue number	11
DOIs	https://doi.org/10.1097/MD.0000000000003118
Publication status	Published - 2016

Bibliographical note

Funding Information:
This work was supported by the Brain Korea PLUS 21 Project for Medical Science, Yonsei University, by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2011-0030711), and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (H10C2020).

Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Medicine(all)

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10.1097/MD.0000000000003118

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Lee, M. J., Kwon, Y. E., Park, K. S., Kee, Y. K., Yoon, C. Y., Han, I. M., Han, S. G., Oh, H. J., Park, J. T., Han, S. H., Yoo, T. H., Kim, Y. L., Kim, Y. S., Yang, C. W., Kim, N. H., & Kang, S. W. (2016). 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. Medicine (United States), 95(11), [e3118]. https://doi.org/10.1097/MD.0000000000003118

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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 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.",

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 Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Kim, {Yong Lim} and Kim, {Yon Su} and Yang, {Chul Woo} and Kim, {Nam Ho} and Kang, {Shin Wook}",

note = "Funding Information: This work was supported by the Brain Korea PLUS 21 Project for Medical Science, Yonsei University, by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2011-0030711), and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (H10C2020). Publisher Copyright: Copyright {\textcopyright} 2016 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2016",

doi = "10.1097/MD.0000000000003118",

language = "English",

volume = "95",

journal = "Medicine (United States)",

issn = "0025-7974",

publisher = "Lippincott Williams and Wilkins",

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Lee, MJ, Kwon, YE, Park, KS, Kee, YK, Yoon, CY, Han, IM, Han, SG, Oh, HJ, Park, JT, Han, SH , Yoo, TH, Kim, YL, Kim, YS, Yang, CW, Kim, NH & Kang, SW 2016, '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', Medicine (United States), vol. 95, no. 11, e3118. https://doi.org/10.1097/MD.0000000000003118

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 et al.

In: Medicine (United States), Vol. 95, No. 11, e3118, 2016.

Research output: Contribution to journal › Article › peer-review

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

N1 - Funding Information: This work was supported by the Brain Korea PLUS 21 Project for Medical Science, Yonsei University, by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2011-0030711), and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (H10C2020). Publisher Copyright: Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2016

Y1 - 2016

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.

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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

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