Glycated hemoglobin predicts overall and cardiovascular mortality in non-diabetic hemodialysis patients

Abstract

Aims: Besides diabetic patients, glycated hemoglobin (HbA(1c)) levels have been reported to predict mortality in non-diabetics patients. However, the importance of HbA(1c) levels in non-diabetic hemodialysis patients still remains unknown. Thus, we aimed to prospectively investigate the impact of HbA(1c) on all-cause and cardiovascular mortality in a large group of prevalent non-diabetic hemodialysis patients. Methods: HbA(1c) was measured quarterly in 489 non-diabetic prevalent hemodialysis patients. Overall and cardiovascular mortality were evaluated over a 3 year follow-up. Results: Mean HbA(1c) level was 4.88 +/- 0.46% (3.5 - 6.9%). During the 28.3 +/- 10.6 months follow-up period, 67 patients (13.7%) died; 31 from cardiovascular causes. In Kaplan-Meier analysis, patients in the lowest (< 4.69%) and highest HbA(1c) (> 5.04%) tertiles had poorer overall survival compared to the middle HbA(1c) tertile (p < 0.001). Adjusted Cox-regression analysis revealed that the highest HbA(1c) tertile was associated with both overall (HR = 3.60, 95% CI 1.57 - 8.27, p = 0.002) and cardiovascular (HR = 6.66, 95% CI 1.51 - 29.4; p = 0.01) mortality. Also, low HbA(1c) levels tended to be associated with overall mortality (HR = 2.26, 95% CI 0.96 - 5.29, p = 0.06). Conclusion: Upper normal HbA(1c) levels are independently associated with cardiovascular and overall mortality in non-diabetic hemodialysis patients, whereas lower HbA(1c) levels are not.