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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

Authors
 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 
Citation
 MEDICINE, Vol.95(11) : 3118, 2016 
Journal Title
MEDICINE
ISSN
 0025-7974 
Issue Date
2016
MeSH
Aged ; Diabetes Mellitus/blood* ; Diabetes Mellitus/mortality* ; Female ; Follow-Up Studies ; Glycated Hemoglobin A/metabolism* ; Humans ; Kidney Failure, Chronic/blood* ; Kidney Failure, Chronic/mortality* ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Propensity Score ; Prospective Studies ; Renal Dialysis/methods* ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate
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.
Files in This Item:
T201600902.pdf Download
DOI
10.1097/MD.0000000000003118
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kwon, Young Eun(권영은)
Kee, Youn Kyung(기연경)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146580
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