洗腎病人的血糖控制和mortality無關

Glycemic Control and Mortality in Hemodialysis Patients

Management of dialysis patients should not be focused on tight glycemic control.

The prevalence of diabetes is high among patients who undergo hemodialysis. To determine whether glycemic control is associated with mortality in dialysis patients, Canadian researchers conducted a retrospective cohort study of 1484 adults (median age, 66) who started hemodialysis in northern Alberta between 2001 and 2007.

In nearly half the patients, diabetic nephropathy was the underlying cause of renal failure; another 13% of patients (who were undergoing dialysis for nondiabetic renal disease) also had diabetes. During median follow-up of 1.5 years, 43% of patients died. In multivariable analyses, neither hemoglobin A1c level nor the average of multiple glucose levels (measured around the time when dialysis was initiated) was associated with mortality.

Comment: Although this study doesn't carry the weight of a randomized trial comparing intensive and less-intensive glycemic control, the results suggests that glycemic control should not be a major focus in the management of patients on hemodialysis. Note, however, that the results of two other recent North American studies conflicted: One demonstrated an association between poorer glycemic control and mortality (Diabetes Care 2007; 30:1049), whereas the other did not (Kidney Int 2006; 70:1503).

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 27, 2010

Citation(s):

Shurraw S et al. Glycemic control and the risk of death in 1,484 patients receiving maintenance hemodialysis. Am J Kidney Dis 2010 May; 55:875.

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