Visit-to-visit HbA1c variability is associated with poor prognosis in peritoneal dialysis patients with type 2
Fengping Zhang1,2, Taotao Shi1,2, Xiaoran Feng2
1Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
Insights
Visit-to-visit HbA1c variability (HVS) is linked to poor prognosis in diabetic peritoneal dialysis patients. Higher HVS independently predicts increased risk of all-cause mortality and major adverse cardiovascular events, offering clinical guidance.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Diabetic patients undergoing peritoneal dialysis (PD) have a poor prognosis.
- Hemoglobin A1c (HbA1c) is a key indicator of glycemic control.
- The impact of HbA1c variability on PD patient outcomes is not well understood.
Purpose of the Study:
- To investigate the association between visit-to-visit HbA1c variability and prognosis in type 2 diabetes mellitus patients on PD.
- To determine if HbA1c variability is an independent predictor of mortality and cardiovascular events.
Main Methods:
- Categorized 820 diabetic PD patients into three groups based on HbA1c variability score (HVS).
- Analyzed all-cause mortality using Cox hazard models.
- Assessed major adverse cardiovascular events using the Fine-Gray competing risk model.
- Conducted subgroup and sensitivity analyses to confirm findings.
Main Results:
- Patients in the highest HVS category (≥2/3) had a 4.59-fold increased hazard for all-cause mortality and a 1.91-fold increased hazard for major adverse cardiovascular events compared to the lowest category (<1/3), after adjustment for confounders.
- Findings were robust across subgroup and sensitivity analyses, including adjustments for time-weighted average HbA1c and measurement frequency.
Conclusions:
- HbA1c variability, quantified by HVS, is an independent predictor of poor prognosis in type 2 diabetes mellitus patients on peritoneal dialysis.
- HVS serves as a novel clinical indicator for risk stratification and management in this patient population.
Background:
The prognosis of diabetic peritoneal dialysis patients is poor. HbA1c serves as a crucial indicator for monitoring blood glucose control in patients with diabetes. Nevertheless, the relationship between visit-to-visit HbA1c variability and prognosis in peritoneal dialysis with diabetes remains unclear.
Methods:
All participants were categorized into 3 groups based on the HbA1c variability score (HVS), which is the frequency of 0.5% (5.5 mmol/mol) alter in visit-to-visit HbA1c values. Then, the hazard ratio to HVS with all-cause mortality was analyzed using the Cox hazard model, followed by the Fine-Gray competing risk model for major adverse cardiovascular events. Subgroup and sensitivity analysis were conducted to ascertain the robustness of the findings.
Results:
Eight hundred twenty patients with type 2 diabetes were finally enrolled in this study from 2,855 participants with a mean age of 56.9 ± 14.6 years and a median follow-up time of 44 months [IQR: 27-70], death occurred in 496 (60.2%) individuals. Compared with the lowest category (HVS < 1/3) after being adjusted by potential confounding factors, the hazard ratio for all-cause mortality was 4.59 (3.74-5.64) and the sub-distribution hazard ratio for major adverse cardiovascular events was 1.91 (1.46-2.51) of the highest category (HVS ≥ 2/3). Subgroup interaction and sensitivity analysis, including the adjustment for variables such as time-weighted average HbA1c, HbA1c measurement times and expansion, confirmed the reliability of the results.
Conclusion:
The HVS is related to the risk of poor prognosis in peritoneal dialysis with type 2 diabetes mellitus, independently of clinical multiple variables, and is a novel indicator with clinical guidance.
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