Diabetes control ups dialysis patients' survival

NEW YORK (Reuters Health) - Diabetic patients with kidney disease who are on dialysis live longer if their blood sugar levels are kept under tight control, researchers report.

Dr. Kamyar Kalantar-Zadeh, of Harbor-UCLA Medical Center, Torrance, California, and colleagues analyzes the database of DaVita, a large dialysis organization based in the U.S., to assess the outcomes of nearly 83,000 patients in DaVita clinics over a 3-year period.

More than 23,000 of the patients had diabetes and had at least one A1C measurement, which reflects blood glucose control over the long term.

Based on the crude data, it looked like higher A1C values were associated "paradoxically" with lower mortality risk over the follow-up period, the investigators report in the medical journal Diabetes Care. However, after taking account of factors such as dialysis duration, anemia, other illnesses and malnutrition, the team found that higher A1C values were tied to a higher mortality risk.

Dr. Kalantar-Zadeh and colleagues found that the increase in death risk associated with rising A1C values was prominent among younger patients, those who had been on dialysis for more than 2 years, and patients with higher protein intakes.

"Diligent glycemic control may be an effective measure to improve survival in chronic kidney disease," the investigators conclude.

SOURCE: Diabetes Care, May 2007.