The Relationship between Variability in Measured HbA1c Values and Survival in Diabetic Patients Undergoing Hemodialysis Treatment

Yıl 2020, , 189 - 194, 01.08.2020

Cihan Uysal , Seher Kır , Nurol Arık

https://doi.org/10.32708/uutfd.722894

Öz

Survival of the diabetic patients, which accounts for approximately one-third of hemodialysis patients, is shorter than non-diabetics. Increase in variability of glucose and HbA1c negatively affects survival in diabetic patients. In this study, we aimed to evaluate the relationship between HbA1c variability and survival in diabetic hemodialysis patients. We evaluated diabetic patients receiving hemodialysis for at least one year and had at least four HbA1c measurements retrospectively. The standard deviation (SD) and coefficient of variation (CV) of the HbA1c, hemoglobin and glucose were used as the index of variability for each patient. The mean age of 38 patients (21M, 17F) was 62.1±11.86 (24-81) years, the mean survival time was 67.4±40.6 months. Twenty (52.6%) patients died in the follow-up. The mean values of hemoglobin, glucose and HbA1c was 10.8±1.0 mg/dl, 87±68 mg/dl and 7.1±1.4%, respectively. The variability was greatest in glucose (31.7%), then in HbA1c (12.4%) and least in hemoglobin (10.6%). In Cox regression analysis, age, chronic kidney disease duration, hemoglobin and HbA1c were found to be related with survival (p=0.036, p=0.001, p=0.001, p=0.001, respectively). There was no relationship between the survival and the SD and CV values calculated for HbA1c, glucose and hemoglobin (p> 0.05, for all). The patients were divided into two groups according to HbA1c values (Group 1:<8.5% and group 2:≥8.5%). and a statistically significant difference was found between the groups by Kaplan-Meier method (p=0.021). We found that the increased HbA1c and decreased hemoglobin values in diabetic hemodialysis patients are associated with an increased risk of mortality, but HbA1c variability is not associated with survival unlike diabetic patients with normal renal function.

Anahtar Kelimeler

Hemodialysis, diabetes, HbA1c variability, chronic renal disease, survival

Hemodiyaliz Tedavisi Gören Diyabetik Hastalarda Ölçülen HbA1c Değerlerindeki Değişkenliğin Sağkalım ile İlişkisi

Öz

Hemodiyaliz hastalarının yaklaşık üçte birini oluşturan diyabetik grupta sağkalım diyabetik olmayanlara kıyasla daha kısadır. Diyabetik hastalarda glukoz ve HbA1c değişkenliğinin artmasının, sağkalımı olumsuz yönde etkilediği gözlenmiştir. Çalışmamızda hemodiyaliz yapılan diyabetik hastalarda HbA1c ölçümlerindeki değişkenlik ile sağkalım arasındaki ilişkiyi değerlendirmeyi amaçladık. Çalışmamızda Ocak 2006 ile Aralık 2014 tarihleri arasında en az bir yıl süreyle merkezimizde hemodiyaliz yapılmış ve en az dört adet HbA1c ölçümü olan diyabetik böbrek yetmezliği hastaları retrospektif olarak değerlendirildi. Her hasta için değişkenlik ölçütü olarak hemodiyaliz yapıldığı süreçte ölçülen HbA1c, hemoglobin ve glukoz ölçümlerinin standart sapma (SD) ve varyasyon katsayısı (CV) kullanıldı. Çalışmaya dahil edilen 38 hastanın (21E, 17K) yaş ortalaması 62,1±11,86 (24-81) yıl ve ortalama sağkalım süresi 67,4±40,6 ay olup 20’si (%52,6) hayatını kaybetmişti. Hastalarda ortalama hemoglobin 10,8±1,0 mg/dl, glukoz 87±68 mg/dl ve HbA1c %7,1±1,4’tü. Değişkenlik en fazla glukozda (%31,7) sonra HbA1c’de (%12,4) ve en az hemoglobindeydi (%10,6). Cox regresyon analizinde sağkalım süresiyle yaş, kronik böbrek hastalığı süresi, ortalama hemoglobin ve HBA1c ilişkili bulundu (p=0,036, p=0,001, p=0,001, p=0,001, sırasıyla). Hastaların HbA1c, glukoz ve hemoglobin ölçümleri için hesaplanan SD ve CV değerleriyle sağkalım süreleri arasında ilişki saptanmadı (p>0,05, her biri için). Hastalar HbA1c’ye göre iki gruba ayırıldı (Grup 1: <%8,5 ve grup 2: ≥%8,5). Sağkalım hızları Kaplan-Meier yöntemi kullanılarak değerlendirildi ve gruplar arasında istatistiksel olarak anlamlı fark saptandı (p=0,021). Elde ettiğimiz veriler diyabetik hemodiyaliz hastalarında artmış HbA1c ve azalmış hemoglobin değerlerinin mortalite riskinde artış ile ilişkili olduğunu fakat normal böbrek fonksiyonuna sahip diyabetik hastalardakinden farklı olarak HbA1c değişkenliğinin sağkalım süresi ile ilişkili olmadığını desteklemektedir.

Anahtar Kelimeler

Hemodiyaliz, diyabet, HBA1c değişkenliği, kronik böbrek hastalığı, sağkalım

Kaynakça

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