ArticleClinical journal of the American Society of Nephrology : CJASN2010
Glycemic control and extended hemodialysis survival in patients with diabetes mellitus: comparative results of traditional and time-dependent Cox model analyses.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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38 citing papers in PubMed, 98 citations in OpenAlex.
- Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients.Journal of the American Society of Nephrology : JASN · 2013Trial
- Glycemic Control in Patients with Diabetes on Peritoneal Dialysis: From Glucose Sparing Approach to Glucose Monitoring.Life (Basel, Switzerland) · 2025Review
- Glycemic Management and Individualized Diabetes Care in Dialysis-Dependent Kidney Failure.Diabetes care · 2025Review
- Diabetes and Glucose Management in People on Hemodialysis.Diabetes spectrum : a publication of the American Diabetes Association · 2025Article
- Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD.Diabetes & metabolism journal · 2023Article
- Inferior Nutritional Status Significantly Differentiates Dialysis Patients with Type 1 and Type 2 Diabetes.Nutrients · 2023Observational
- Pathophysiological concepts and screening of cardiovascular disease in dialysis patients.Frontiers in nephrology · 2023Review
- Making sense of glucose sensors in end-stage kidney disease: A review.Frontiers in clinical diabetes and healthcare · 2022Review
- Risk Factors Associated with All-Cause Death Among Dialysis Patients with Diabetes.Medical science monitor : international medical journal of experimental and clinical research · 2021Observational
- Glucose Homeostasis, Hypoglycemia, and the Burnt-Out Diabetes Phenomenon in Kidney Disease.Seminars in nephrology · 2021Review
- Glycemic Monitoring and Management in Advanced Chronic Kidney Disease.Endocrine reviews · 2020Review
- Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus.Kidney international reports · 2020Article
- Association of Glycemic Status During Progression of Chronic Kidney Disease With Early Dialysis Mortality in Patients With Diabetes.Diabetes care · 2017Article
- Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus.Journal of the American Heart Association · 2017Article
- Determinant Effects of Average Fasting Plasma Glucose on Mortality in Diabetic End-Stage Renal Disease Patients on Maintenance Hemodialysis.Kidney international reports · 2017Article
- Diabetes mellitus and renal failure: Prevention and management.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2015Review
- Haemodialysis-induced hypoglycaemia and glycaemic disarrays.Nature reviews. Nephrology · 2015Review
- Long-term efficacy of vildagliptin in patients with type 2 diabetes undergoing hemodialysis.Journal of diabetes and metabolic disorders · 2015Article
- Impact of Hydroxychloroquine on Atherosclerosis and Vascular Stiffness in the Presence of Chronic Kidney Disease.PloS one · 2015Article
- HbA1c and survival in maintenance hemodialysis patients with diabetes in Han Chinese population.International urology and nephrology · 2014Observational
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesThe benefits and risks of aggressive glycemic control in diabetes mellitus complicated by end-stage kidney failure remain uncertain but have importance because of the large patient population with inferior overall prognosis. Recent large observational studies with differing methodologies reached somewhat contrasting conclusions regarding the association of hemoglobin A1c with survival in diabetic chronic hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study supplements the authors' previous analysis (which found no correlation) by extending the follow-up period to 3 years and using time-dependent survival models with repeated measures. Among 24,875 nationally distributed study patients, 94.5% had type 2 diabetes, allowing additional analysis in the subset with type 1 diabetes. Data were collected at baseline and every quarter to a maximum of 3 years' follow-up.
resultsAdjusted standard and time-dependent Cox models indicated that only extremes of glycemia were associated with inferior survival. There was no effect modification by serum albumin levels, a marker of protein nutrition status, and no trend associated with random glucose measurements in a post hoc analysis. In type 1 diabetic patients, upper extreme hemoglobin A1c values indicated lower survival risk.
conclusionsSustained extremes of glycemia were only variably and weakly associated with decreased survival in this population. In the absence of randomized, controlled trials, these results suggest that aggressive glycemic control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk. Physicians are encouraged to individualize glycemic targets based on potential risks and benefits in diabetic ESRD patients.
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