SP576
DETERMINANT EFFECTS OF AVERAGE FASTING PLASMA GLUCOSE ON MORTALITY IN DIABETIC END-STAGE RENAL DISEASE ON MAINTENANCE HEMODIALYSIS: AN INVESTIGATION USING DATA FROM THE TAIWAN RENAL REGISTRY DATA SYSTEM FROM 2005 TO 2012

Introduction and Aims: Diabetic kidney disease is the leading cause of end-stage renal disease with an increasing incidence. Treatment of diabetic uremia patients is challenging because the association between glucose level, which is primarily represented by glycated hemoglobin (HbA1c), and mortality shows mixed results in epidemiological studies. We assessed the relation between the 1 year or 3-year average fasting glucose levels after the initiation of hemodialysis and mortality in diabetic patients undergoing hemodialysis during the study period.

Methods: We included patients with diabetes mellitus receiving hemodialysis from the Taiwan Renal Registry Data System (TWRDS) from January 2005 and December 2012. For each patient, the 1-year and 3-year average fasting glucose levels were calculated using the uploaded seasonal laboratory data. The patients were grouped into quartiles by the 1-year and 3-year average glucose levels. By comparing each patient’s group change between the 1-year and 3-year glucose levels, they were further divided into the decrease group or increase group. The 3-year all-cause mortality was the primary outcome. Survival analysis was conducted using Cox regression analysis with the crude or adjusted explanatory models.

Results: A total of 46,332 hemodialysis patients combined with diabetes were identified. The mean fasting glucose levels for the first year were 103.5 ± 14.5, 144.7 ± 11.5, 189.6 ± 15.2, and 280.8 ± 61.2 mg/dL in the first quartile (lowest), second quartile, third quartile, and fourth quartile (highest), respectively. The mean 3-year fasting glucose levels were 107.6 ± 14.6, 147.7 ± 10.8, 188.3 ± 13.3, and 268.1 ± 54.4 mg/dL in the first quartile (lowest), second quartile, third quartile, and fourth quartile (highest), respectively. The Kaplan-Meier survival curve of four quartiles by 1-year and 3-year average fasting glucose levels showed an incremental reduction of 3-year survival as the glucose levels increased (41% and 50.3% reduction compared to the highest quartile to lowest quartile in the 1-year and 3-year average glucose groups, p < 0.0001). In the Cox regression model for death by four quartiles of the 1-year average fasting glucose, the adjusted hazard ratios were 1.15 [95% confidence interval (CI) 1.10-1.20], 1.30 (95% CI 1.25-1.36), and 1.45 (95% CI 1.39-1.51) in the second quartile, third quartile, and fourth quartile, respectively, when compared to the first quartile. The adjusted hazard ratios for death by four quartiles of 3-year average fasting glucose were 1.17 (95% CI 1.12-1.22), 1.26 (95% CI 1.21-1.31), and 1.57 (95% CI 1.51-1.64) in the second quartile, third quartile, and fourth quartile, respectively, when compared to the first quartile. The glucose increase group had a 22% increased (95% CI 1.16-1.29) risk of all-cause mortality compared to the glucose decrease group.

Conclusions: The 1-year and 3-year average fasting glucose levels after hemodialysis are positively associated with mortality. Compared to the glucose decrease group, the increase group had a 22% increase in the risk of all-cause mortality.