Comparison of Glycated Albumin and Hemoglobin A1cConcentrations in Diabetic Subjects on Peritoneal and Hemodialysis

BackgroundRelative to hemoglobin A1c(HbA1c), percentage of glycated albumin (GA%) more accurately reflects recent glycemic control in diabetic hemodialysis (HD) patients.MethodsTo determine the accuracy of glycemic assays in a larger sample including patients on peritoneal dialysis (PD), HbA1cand GA% were measured in 519 diabetic subjects: 55 on PD, 415 on HD, and 49 non-nephropathy controls.ResultsMean ± SD serum glucose levels were higher in HD and PD patients relative to non-nephropathy controls (HD 169.7 ± 62 mg/dL, PD 168.6 ± 66 mg/dL, controls 146.1 ± 66 mg/dL; p = 0.03 HD vs controls, p = 0.13 PD vs controls). GA% was also higher in HD and PD patients (HD 20.6% ± 8.0%, PD 19.0% ± 5.7%, controls 15.7% ± 7.7%; p < 0.02 HD vs controls and PD vs controls). HbA1cwas paradoxically lower in dialysis patients (HD 6.78% ± 1.6%, PD 6.87% ± 1.4%, controls 7.3% ± 1.4%; p = 0.03 HD vs controls, p = 0.12 PD vs controls). The serum glucose/HbA1cratio differed significantly between dialysis patients and controls ( p < 0.0001 HD vs controls, p = 0.002 PD vs controls), while serum glucose/GA% ratio was similar across groups ( p = 0.96 HD vs controls, p = 0.64 PD vs controls). In best-fit multivariate models with HbA1cor GA% as outcome variable, dialysis status was a significant predictor of HbA1cbut not GA%.ConclusionsThe relationship between HbA1cand GA% differs in diabetic patients with end-stage renal disease who perform either PD or HD compared to those without nephropathy. HbA1csignificantly underestimates glycemic control in peritoneal and hemodialysis patients relative to GA%.

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Successful Continuation of Peritoneal Dialysis after "Sweet" Hydrothorax

BANTAO Journal ◽

10.1515/bj-2015-0009 ◽

2015 ◽

Vol 13 (1) ◽

pp. 42-45

Author(s):

Utku Erdem Soyaltin ◽

Ferhat Ekinci ◽

Denizhan Ayatan ◽

Cihangir Turemis ◽

Mustafa Yildirim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Glucose Concentration ◽

Serum Glucose ◽

X Ray ◽

Glucose Levels ◽

Low Protein ◽

Elevated Glucose ◽

Chest X Ray ◽

Stage Renal Disease ◽

End Stage

AbstractA 44-year-old woman with end-stage renal disease presented with dyspnea on exertion and a vague chest pain about two weeks after commencing continuous ambulatory peritoneal dialysis (CAPD) four months ago. A chest x-ray revealed massive unilateral right-sided pleural effusion. Laboratory analysis of the effusion revealed low protein and lactate dehydrogenase but elevated glucose levels were consistent with transudate and pleuroperitoneal leakage. Pleural glucose concentration was much higher than patients’ serum glucose concentration, which was suggestive of "sweet" hydrothorax because of this high glucose concentration. It is advisable to keep this condition in mind among the differenttial diagnoses of hydrothorax in patients on CAPD.

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Mortality after amputation in dialysis patients is high but not modified by diabetes status

Clinical Kidney Journal ◽

10.1093/ckj/sfz116 ◽

2019 ◽

Vol 13 (6) ◽

pp. 1077-1082 ◽

Cited By ~ 1

Author(s):

Marielle A Schroijen ◽

Merel van Diepen ◽

Jaap F Hamming ◽

Friedo W Dekker ◽

Olaf M Dekkers

Keyword(s):

Mortality Risk ◽

Interaction Analysis ◽

Diabetic Patients ◽

Comorbid Conditions ◽

Dialysis Patients ◽

Diabetes Status ◽

Patients With Diabetes ◽

Stage Renal Disease ◽

End Stage ◽

Incident Cases

Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.

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Peripheral Vascular Disease in Diabetic Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080702702s36 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 210-214 ◽

Cited By ~ 1

Author(s):

Heikki H.T. Saha ◽

Yrjö K.J. Leskinen ◽

Juha P. Salenius ◽

Jorma T. Lahtela

Keyword(s):

Peritoneal Dialysis ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Current Knowledge ◽

Diabetic Patients ◽

Peripheral Vascular ◽

Dialysis Patients ◽

Stage Renal Disease ◽

End Stage ◽

Review Current

In the present article, we review current knowledge of the epidemiology, diagnosis, and treatment of peripheral vascular disease in patients with end-stage renal disease. The main focus is placed on diabetic patients receiving peritoneal dialysis, but studies on patients receiving hemodialysis are also reviewed, because most reports involve this patient group, and the number of reports on peripheral vascular disease in PD patients alone is limited.

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Knowledge of Disease and Dietary Compliance in Patients with End-Stage Renal Disease

Psychological Reports ◽

10.2466/pr0.1998.82.1.331 ◽

1998 ◽

Vol 82 (1) ◽

pp. 331-336 ◽

Cited By ~ 11

Author(s):

Roger C. Katz ◽

Jay Ashmore ◽

El Via Barboa ◽

Karen Trueblood ◽

Veronica McLaughlin ◽

...

Keyword(s):

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Well Being ◽

Dialysis Patients ◽

Dietary Compliance ◽

Interdialytic Weight Gain ◽

Stage Renal Disease ◽

End Stage ◽

The Relationship

Noncompliance is a common problem in patients with end-stage renal disease. In this study, we assessed the relationship between knowledge of disease and dietary compliance in a cohort of 56 dialysis patients. Based on a health belief model of adherence, we predicted that dialysis patients who knew more about kidney disease and its treatment would be more compliant than those who knew less about these matters. We also examined the relationship between dietary compliance and patients' emotional well-being. We used a composite measure of compliance consisting of serum K, P, and interdialytic weight gain. A 30-item “Kidney Disease Questionnaire” was used to assess patients' knowledge of their illness. Contrary to prediction, compilers did not score higher on the knowledge questionnaire; in fact, the observed correlation of .32 was in the opposite direction. In the same vein, we found no relationship between compliance and emotional well-being. These results, although somewhat surprising, add to a growing body of research which indicates that medical compliance involves more than educating patients about the mechanisms and treatment of their illness.

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An Observational Study on Depressive Illness in Hemodialysis Recipients: A Review on its Association and Prognostication

Bangladesh Critical Care Journal ◽

10.3329/bccj.v8i1.47708 ◽

2020 ◽

Vol 8 (1) ◽

pp. 41-47

Author(s):

Umme Salma Talukder ◽

Hossain Tameem Bin Anayet ◽

Samjhana Mandal ◽

MM Jalal Uddin ◽

Fahmida Ahmed ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Renal Disease ◽

End Stage Renal Disease ◽

Physical Symptoms ◽

Diabetic Patients ◽

Dialysis Patients ◽

Major Depressive ◽

Stage Renal Disease ◽

End Stage

Major Depressive Disorder (MDD) is one of the most common psychiatric illnesses. The effect of depression on one’s physical health is well-known, which can include anything from weight gain or loss to chronic illnesses such as heart disease, kidney or gastrointestinal problems. Provided the increasing prevalence of patients suffering from End Stage Renal Disease (ESRD) and receiving hemodialysis treatment, it is important to investigate how MDD affects the outcome of their treatment. The incidence of depression in dialysis patients ranges from 10% to 66% in various studies, with prevalence reaching as high as 100%. The purpose of this article is to find the prevalence and severity of major depressive disorder in dialysis patients as well as to describe the possible pathways MDD worsens the dialysis outcome. Our study population consisted of 51 End Stage Renal Disease (ESRD) patients sampled from the Department of Nephrology at BIRDEM General Hospital. Neurocognitive, physical symptoms, the severity of MDD and presence of comorbid conditions including diabetics and hypertension, were measured in our study. The ESRD patient sample consisted 47.7% moderately depressed patients, 34% severely depressed, 11.4% mild and 6.8% with minimal MDD patients. Analogous to Hypertension and Diabetic patients with depression, the number of Chronic Kidney Disease (CKD) patients with mostly moderate severe depression increased with the duration of the disease. The article explains a myriad of biologic, behavioral, genetic and social factors underlying the association of depression and adverse medical outcomes in patients with CKD and ESRD. Moreover, neuroimaging data is required for further discussion on relationship between Depression and CKD. The implication of this study is to emphasize the importance of dialysis patients’ overall health and to serve as a pretext for further research into depression in dialysis patients. Bangladesh Crit Care J March 2020; 8(1): 41-47

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