Glycemic Control and Survival in Peritoneal Dialysis Patients with Diabetes Mellitus

Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c ran-dom serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r 0.51). Adjusted all-cause death hazard ratio and 95 % confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and 10%, compared with 6.0 to 6.9 % (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in non-anemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c incre