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Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
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Uncontrolled Diabetes is a Strong Predictor of Amputation in End Stage Renal Disease Patients on Hemodialysis

Arthur Tarricone1, Allen Gee2, Andrew J Boulton3

  • 1Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Annals of Vascular Surgery
|December 30, 2024
PubMed

Insights

In patients with end-stage renal disease, higher Hemoglobin A1C (HBA1C) levels are linked to increased amputation risk but paradoxically lower mortality. This suggests HBA1C is a reliable amputation marker but its survival prediction role needs further investigation.

Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Medicine

Background:

  • Diabetic nephropathy is a key driver of chronic kidney disease progression.
  • Hemoglobin A1C (HBA1C) is a standard indicator for diabetes complications.
  • Understanding HBA1C's role in end-stage renal disease (ESRD) patients is crucial.

Purpose of the Study:

  • To investigate the association between HBA1C levels and clinical outcomes in ESRD patients.
  • To determine if HBA1C predicts complications in dialysis patients.
  • To evaluate HBA1C as a marker for amputation and mortality in ESRD.

Main Methods:

  • Prospective study involving ESRD patients undergoing hemodialysis or peritoneal dialysis in Texas.
  • Utilized a cutoff of HBA1C ≥ 6.5% to define well-controlled versus uncontrolled diabetes.
  • Collected data on clinical complications, specifically amputation and mortality.

Main Results:

  • An HBA1C level of 6.5% or higher strongly correlated with both minor (P=0.0014) and major (P=0.006) amputations.
  • Patients with HBA1C ≥ 6.5% exhibited significantly lower mortality rates compared to those with HBA1C < 6.5% (P=0.007).

Conclusions:

  • HBA1C serves as a dependable predictor of amputation risk in the ESRD population.
  • The utility of HBA1C as a prognostic marker for survival in ESRD patients warrants further scrutiny and debate.
Abstract

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