POOR PREDIALYSIS GLYCEMIC CONTROL IS A PREDICTOR OF MORTALITY IN TYPE-II DIABETIC-PATIENTS ON MAINTENANCE HEMODIALYSIS

Background. In type II diabetic patients, a better glycaemic control h as been reported to slow down the progression of nephropathy. The effe ct of pre-dialysis glycaemic control on the long term prognosis in typ e II diabetics on haemodialysis is still uncertain. The purpose of thi s study is to evaluate the effect of glycaemic control before starting maintenance haemodialysis on the clinical outcome in type II diabetic haemodialysis patients. Methods. One hundred and thirty-seven type II diabetics receiving regular haemodialysis in a single university hosp ital were enrolled. The patients were classified as either good or poo r glycaemic control group according to their glycaemic control within 6 months before starting haemodialysis. Serum albumin, haematocrit, ch olesterol, triglyceride, residual renal function, diabetic complicatio ns, and patient survival were analysed in both groups. Results. There was no significant difference in age, gender, predialysis albumin leve l, cholesterol level, triglyceride level, and residual renal function between the two groups. The 1-year (94.5% vs 80.0%), 3-year (82.9% vs 58.1%), and 5-year (75.8% vs 21.8%) cumulative survival rates were low er in the poor glycaemic control group than in the good glycaemic cont rol group (P < 0.001). The poor glycaemic control group also had more cardiovascular morbidity during the period of dialysis (P < 0.001). Th e increase in cardiovascular complications also accounted for the incr eased mortality during the course of haemodialysis. Conclusions. We co nclude that poor glycaemic control before starting dialysis is a stron g predictor of cardiovascular morbidity and survival for type II diabe tics on haemodialysis. These results imply that better glycaemic contr ol before dialysis might be important in improving the long-term progn osis in type II diabetics on haemodialysis.