Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease

Jinnie J. Rhee, Victoria Y. Ding, David H. Rehkopf, Cristina M. Arce, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in endstage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease. Methods: Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011. Results: Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %. Conclusion: In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.

Original languageEnglish (US)
Article number204
JournalBMC Nephrology
Volume16
Issue number1
DOIs
StatePublished - Dec 9 2015

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Chronic Kidney Failure
Renal Dialysis
North American Indians
Hispanic Americans
Dialysis
Body Mass Index
Blood Pressure
Kidney
Electronic Health Records
Glycosylated Hemoglobin A
Censuses
Ferritins
Glomerular Filtration Rate
Platelet Count
Leukocyte Count
Information Systems
Malnutrition
Lipoproteins
Albumins
Diabetes Mellitus

Keywords

  • Diabetes mellitus
  • Electronic health records
  • End-stage renal disease
  • Glycemic control
  • Hemodialysis
  • USRDS

ASJC Scopus subject areas

  • Nephrology

Cite this

Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease. / Rhee, Jinnie J.; Ding, Victoria Y.; Rehkopf, David H.; Arce, Cristina M.; Winkelmayer, Wolfgang C.

In: BMC Nephrology, Vol. 16, No. 1, 204, 09.12.2015.

Research output: Contribution to journalArticle

Rhee, Jinnie J. ; Ding, Victoria Y. ; Rehkopf, David H. ; Arce, Cristina M. ; Winkelmayer, Wolfgang C. / Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease. In: BMC Nephrology. 2015 ; Vol. 16, No. 1.
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AU - Winkelmayer, Wolfgang C.

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N2 - Background: Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in endstage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease. Methods: Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011. Results: Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %. Conclusion: In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.

AB - Background: Maintaining tight glycemic control is important for prevention of diabetes-related outcomes in endstage renal disease patients with diabetes, especially in light of their poor prognosis. This study aimed to determine factors associated with poor glycemic control among U.S. patients with diabetes mellitus initiating hemodialysis for end-stage renal disease. Methods: Using data from the U.S. Renal Data System, electronic health records of a large national dialysis provider, and U.S. Census data, we performed a cross-sectional multivariable Poisson regression analysis to characterize risk factors associated with poor glycemic control, defined as glycated hemoglobin (HbA1c) >7 vs. ≤7 %, in adult patients with diabetes who initiated hemodialysis at an outpatient facility between 2006 and 2011. Results: Of 16,297 patients with diabetes, 21.2 % had HbA1c >7 %. In multivariable analysis, younger patients, patients of Native American race, and those of Hispanic ethnicity had higher prevalence of poor glycemic control. Independent correlates of poor glycemic control further included higher platelet count, white blood cell count, and ferritin; higher body mass index, systolic blood pressure, total cholesterol and triglyceride concentrations; lower HDL and albumin concentrations; lower normalized protein catabolic rate; and higher estimated glomerular filtration rate at initiation of dialysis (all P < 0.05). No independent associations were found with area-level socioeconomic indicators. Occurrence of diabetes in patients <40 years of age, a proxy for type 1 diabetes, was associated with poor HbA1c control compared with that in patients ≥40 years of age, which was classified as type 2 diabetes. These findings were robust to the different outcome definitions of HbA1c >7.5 % and >8 %. Conclusion: In this cohort of incident end-stage renal disease patients with diabetes, poor glycemic control was independently associated with younger age, Native American race, Hispanic ethnicity, higher body mass index, and clinical risk factors including atherogenic lipoprotein profile, hypertension, inflammation, and markers indicative of malnutrition and a more serious systemic disease.

KW - Diabetes mellitus

KW - Electronic health records

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KW - Glycemic control

KW - Hemodialysis

KW - USRDS

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