Marked Hyperglycemia Raises Death Risk in PD Patients

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PHOENIX—Marked hyperglycemia in diabetic patients on chronic peritoneal dialysis (CPD) are at increased risk of death, a study found.

Investigators led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the Harold Simmons Center, Harbor-UCLA Medical Center, Torrance, Calif., studied 2,798 diabetic CPD patients with hemoglobin A1c (HbA1c) measurements. Subjects had a mean age of 58 years. The study population was 44% female, 20% African American, and 16% Hispanic. Compared with patients who had a glucose concentration of 100 to 150 mg/dL, those with a concentration of 300 or greater had a 22% increased six-year death risk, after adjusting for gender, race, age, case-mix, and numerous other potential confounders.

Compared with subjects with an HbA1c value of 5%-6%, those with an HbA1c value above 7% or below 5% had as much as a twofold increased risk of death, Dr. Kalantar-Zadeh said. The increased mortality associated with an HbA1c value below 5% may be related to poor nutritional status or other comorbid conditions.

In addition, he and his colleagues observed a more pronounced association between hyperglycemia and mortality among certain subgroups, such as Caucasians and male patients.

Dr. Kalantar-Zadeh, who presented findings at the 31st Annual Dialysis Conference, observed that glucose loading via PD fluid may exacerbate glycemic problems in diabetic patients.

Study findings are scheduled to appear in the Clinical Journal of the American Society of Nephrology.

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