Abstract
Background:
Diabetes is the leading cause of kidney failure globally affecting 40% of people receiving peritoneal dialysis (PD). High quality data on the potential impact of improving glycemic control is needed to inform the current recommendations to individualise HbA
1C
targets.
Methods:
Data from eight countries in the prospective cohort Peritoneal Dialysis Outcomes and Practice Patterns Study (2014-2022) was used to assess the association between baseline HbA
1C
and all-cause mortality in people with Type 2 diabetes on PD for at least 90 days. Cox proportional hazards model adjusted for potential confounders assessed the relationship in the whole cohort and subgroups. Using inverse probability weighting, an average treatment effect in the treated analysis further investigated potential implications of improved glycemic control.
Results:
HbA
1C
was measured at least once in 8,436 patients during a mean follow-up of 16 months. Compared with HbA
1C
≤8%, HbA
1C
>8% was associated with higher risk of all-cause mortality in the cohort as a whole (HR 1.18 p=0.02 95%CI 1.03-1.35) and within subgroups; aged 3.0g/dL (HR 1.25 p=0.004 95% CI 1.07-1.46), no pre-existing coronary artery disease (HR 1.24 p=0.008 95% CI 1.06-1.46), haemoglobin 1C
≤8% compared with >8% was 7% overall, increasing to 12% in younger cohorts (aged
Conclusions:
Associations between HbA
1C
and mortality argue for tighter individualised targets for patient subgroups (younger, non-inflamed, without established CAD). Our weighted analysis suggests improved glycemic control (reducing HbA
1C
to <8%) may result in an absolute reduction in mortality at three years of up to 12% in younger cohorts.