PREDIALYSIS GLYCEMIC CONTROL IS AN INDEPENDENT PREDICTOR OF CLINICAL OUTCOME IN TYPE-II DIABETICS ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Objective: To evaluate the correlation between predialysis glycemic co ntrol and clinical outcomes for type II diabetic patients on continuou s ambulatory peritoneal dialysis (CAPD). Design: Sixty type II diabeti c patients on CAPD were classified into 2 groups according to the stat us of glycemic control. In group G (good glycemic control), more than 50% of blood glucose determinations were within 3.3 - 11 mmol/L and th e glycosylated hemoglobin (HbA1C) level was within 5 - 10% at all time s. In group P (poor glycemic control), fewer than 50% of blood glucose determinations were within 3.3 - 11 mmol/L or HbA1C level was above 1 0% at least once during the follow-up duration. In addition to glycemi c control status, predialysis serum albumin, cholesterol levels, resid ual renal function, peritoneal membrane function, and the modes of gly cemic control were also recorded. Setting: Dialysis Unit, Department o f Nephrology of a single university hospital. Patients: From February 1988 to October 1995, 60 type II diabetic patients receiving CAPD for at least 3 months were enrolled. Main Outcome Measures: Morbidities be fore and during the dialysis period, patient survival, and causes of m ortality. Results: The patients with good glycemic control had signifi cantly better survival than patients with poor glycemic control (p < 0 .01). There was no significant difference in predialysis morbidity bet ween the two groups. No significant differences were observed in patie nt survival between the patients with serum albumin greater than 30 g/ L and those with less than 30 g/L (p = 0.77), with cholesterol levels greater or less than 5.18 mmol/L (p = 0.73), and with different perito neal membrane solute transport characteristics evaluated by peritoneal equilibration test (p = 0.12). Furthermore, there was no significant difference in survival whether the patients controlled blood sugar by diet or with insulin (p = 0.33). Cardiovascular disease and infection were the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mo rtality in diabetics maintained on CAPD. Conclusions: Glycemic control before starting dialysis is a predictor of survival for type II diabe tics on CAPD. Patients with poor glycemic control predialysis are asso ciated with increased morbidity and shortened survival.