Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus

Authors

Jinnie J Rhee
Yuanchao Zheng
Sai Liu
Maria E Montez-Rath
Richard J Hamill
Julie H Ishida
Wolfgang C Winkelmayer

Publication Date

7-1-2020

Journal

Kidney International Reports

DOI

10.1016/j.ekir.2020.04.020

PMID

32647759

PMCID

PMC7335954

PubMedCentral® Posted Date

4-29-2020

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

diabetes mellitus, epidemiology, glycemic control, hemodialysis, infections

Abstract

INTRODUCTION: Patients with diabetes mellitus (DM) on hemodialysis (HD) may be particularly vulnerable to infections.

METHODS: We used merged data from the United States Renal Data System and electronic health records data from a large US dialysis provider to retrospectively examine the association between glycemic control and infections in these patients. Adult patients with DM aged ≥18 years who initiated in-center maintenance HD treatment from 2006 to 2011 and survived >90 days were included. Quarterly mean time-averaged hemoglobin A1c (HbA1c) values were categorized into

RESULTS: In a cohort of 33,753 eligible patients, those with higher HbA1c levels had higher rates of diabetic foot infections and skin and soft tissue infections, with patients with HbA1c ≥8.5% having 23% (95% CI, 5%, 45%) and 22% (95% CI, 5%, 42%) higher rates, respectively, compared with HbA1c 5.5 to

CONCLUSION: This study highlights the need for greater attention to foot evaluation and skin and soft tissue infections among patients on HD with less than optimal diabetes control.

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