TY - JOUR
T1 - Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease
AU - Rhee, Jinnie J.
AU - Ding, Victoria Y.
AU - Rehkopf, David H.
AU - Arce, Cristina M.
AU - Winkelmayer, Wolfgang C.
N1 - Funding Information:
J.J.R was supported by National Institutes of Health-National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) grants T32 DK007357 and F32 DK103473. D.H.R was supported by the National Institute on Aging grant K01 AG047280. This study was conducted under data use agreements between W.C.W and the NIDDK and DaVita Inc., respectively. Data reported herein were supplied by the USRDS. Interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government. An NIDDK officer reviewed the manuscript for compliance with federal research regulations and approved its submission for publication. Data acquisition was supported by grants R01 DK090181 and R01 DK095024.
Publisher Copyright:
© 2015 Rhee et al.
PY - 2015/12/9
Y1 - 2015/12/9
N2 - Background: Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in endstage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease. Methods: Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011. Results: Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %. Conclusion: In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.
AB - Background: Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in endstage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease. Methods: Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011. Results: Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %. Conclusion: In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.
KW - Diabetes mellitus
KW - Electronic health records
KW - End-stage renal disease
KW - Glycemic control
KW - Hemodialysis
KW - USRDS
UR - http://www.scopus.com/inward/record.url?scp=84949239146&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84949239146&partnerID=8YFLogxK
U2 - 10.1186/s12882-015-0204-4
DO - 10.1186/s12882-015-0204-4
M3 - Article
C2 - 26645204
AN - SCOPUS:84949239146
SN - 1471-2369
VL - 16
JO - BMC Nephrology
JF - BMC Nephrology
IS - 1
M1 - 204
ER -