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Glycaemic control is a predictor of infection‐related hospitalization on haemodialysis patients: M iyazaki D ialysis C ohort study ( MID study)
Author(s) -
Toida Tatsunori,
Sato Yuji,
Nakagawa Hideto,
Komatsu Hiroyuki,
Kikuchi Masao,
Uezono Shigehiro,
Yamada Kazuhiro,
Ishihara Tabito,
Hisanaga Shuichi,
Kitamura Kazuo,
Fujimoto Shouichi
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12587
Subject(s) - medicine , glycemic , diabetes mellitus , hazard ratio , proportional hazards model , type 2 diabetes , endocrinology , confidence interval
Aim Although infection is the second leading cause of death in maintenance haemodialysis patients, the effects of glycaemic control on infection in diabetic haemodialysis patients have not yet been examined in detail. We examined the relationship between diabetes or glycemic control and infection‐related hospitalization (IRH) in haemodialysis patients. Methods Patients receiving maintenance haemodialysis ( n = 1551, 493 diabetic patients) were enrolled in this prospective cohort study in D ecember 2009 and followed‐up for 3 years. IRH during the follow‐up period was abstracted from medical records. K aplan– M eier and C ox regression analyses were used to investigate the relationship between diabetes or glycaemic control and IRH . Results The Kaplan–Meier analysis revealed that the risk of IRH was significantly higher in haemodialysis patients with diabetes, particularly in those with poorly controlled HbA1c levels ( HbA1c ≥ 7.0%), than in haemodialysis patients without diabetes. When patients with ≥ HbA1c 7.0% were divided into two groups using a median value of HbA1c , the risk of IRH was significantly higher in those with the poorest glycaemic control ( HbA1c ≥ 7.4%), an older age, or lower albumin levels. The multivariable‐adjusted hazard ratio for the risk of IRH was not higher in the second criteria of HbA1c ( HbA1c 7.0–7.3%), but was significantly higher in the group with the poorest glycaemic control ( HbA1c ≥ 7.4%) than in those in the good control criterion ( HbA1c < 7.0%). Conclusions Although diabetes is a risk factor for IRH among maintenance haemodialysis patients, the relationship between glycaemic control and the risk of infection is not linear. Therefore, the risk of infection may increase in a manner that is dependent on the glycaemic control threshold.