Glycemic control and survival of diabetic hemodialysis patients-Importance of lower hemoglobin A1C levels

Aims: The significance of hemoglobin A1C (HbA1C) on the survival of diabetic hemodialysis patients still remains controversial. We investigated the impact of HbA1C on the survival. Methods: A total of 122 diabetic patients on maintenance hemodialysis (age, 59.9 +/- 11.9 years [mean +/- SD]; hemodialysis duration: 53 38 months) were surveyed (survey period: 46 19 months). Results: The cumulative survival of the poor glycemic control group (mean HbA1C of 3-month period >= 6.3%, n = 62) was significantly lower than that of the good group (HbA1C < 6.3%, n = 60), as determined by Kaplan-Meier estimation (P = 0.0084, log-rank test). Kaplan-Meier analysis also demonstrated that both cardiovascular and non-cardiovascular mortalities were higher in the poor group than in the good group (P = 0.0545 and P = 0.0453, respectively). In a multivariate Cox proportional hazard model, the mean HbA1C was a significant predictor of survival (OR 1.260 per 1.0%, 95% CI 1.020-0.579, P = 0.0325). Conclusions: Poor glycemic control is an independent predictor of poor prognosis in diabetic hemodialysis patients. HbA1C is a clinically useful parameter for identifying the risk for mortality, both for cardiovascular and non-cardiovascular mortality, and that careful management of glycemic control by use of HbA1C is important. (C) 2008 Elsevier Ireland Ltd. All rights reserved.