Glycemic Control as a Predictor of Myocardial Stress in Patients with Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis

Q: What are the key findings of this study?

Poor glycemic control (HbA1c ≥7.0%) was associated with higher NT-proBNP levels (628.3 vs 549.5 pg/mL; p=0.04) and independently predicted elevated NT-proBNP (OR 1.45; 95% CI 1.02–2.05) in T2DM hemodialysis patients.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes mellitus and diabetic nephropathy undergoing maintenance hemodialysis (CKD stage 5D) (n=60). Intervention: Poor glycemic control (HbA1c ≥7.0%) vs. Adequate glycemic control (HbA1c <7.0%). Primary outcome: Elevated NT-proBNP levels (myocardial stress) (OR 1.45, 95% CI 1.02–2.05, p=0.04).

Q: What does this research mean for the field?

In patients with type 2 diabetes mellitus undergoing maintenance hemodialysis, poor glycemic control (HbA1c ≥7.0%) is independently associated with elevated NT-proBNP levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Даминова Лола Турғунпулатовна; Sitora Muminova; Khurshida Nasirova; Rano B. Alieva; Barkamol Jumaboeva

doi:10.70626/cardiouz-2026-3-00095

September 30, 2026Cardiology of Uzbekistan.Open Access

Glycemic Control as a Predictor of Myocardial Stress in Patients with Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis

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Key result

Poor glycemic control linked to ~45% higher odds of elevated NT-proBNP in hemodialysis patients.

OR 1.45
95% CI 1.02–2.05
P=0.04
n=60

Why the study?

Is poor glycemic control (HbA1c ≥7.0%) associated with elevated NT-proBNP levels in patients with type 2 diabetes mellitus and diabetic nephropathy undergoing maintenance hemodialysis?

Key Points

To assess the relationship between glycemic control and NT-proBNP levels in patients with type 2 diabetes mellitus and diabetic nephropathy undergoing maintenance hemodialysis.
Cross-sectional study of 60 patients with type 2 diabetes mellitus and diabetic nephropathy receiving maintenance hemodialysis (CKD stage 5D).
Patients were stratified by glycated hemoglobin into two groups: HbA1c <7.0% (n=26) and HbA1c ≥7.0% (n=34).
Serum NT-proBNP concentrations were compared across groups using Spearman correlation and binary logistic regression analysis.
Patients with HbA1c ≥7.0% had significantly higher NT-proBNP levels compared with those with HbA1c <7.0% (628.3 vs. 549.5 pg/mL; p = 0.04).
A moderate positive correlation between HbA1c and NT-proBNP was observed in patients with HbA1c ≥7.0% (r=0.34; p=0.049), whereas no significant correlation was found when HbA1c was <7.0% (r=0.15; p=0.45).
Binary logistic regression identified HbA1c as an independent predictor of elevated NT-proBNP (OR=1.45; 95% CI 1.02–2.05; p=0.04), with an AUC of 0.80.

Study Design

Type

Cross-Sectional (n=60)

Multicenter

No

Structured PICO

Is poor glycemic control (HbA1c ≥7.0%) associated with elevated NT-proBNP levels in patients with type 2 diabetes mellitus and diabetic nephropathy undergoing maintenance hemodialysis?

P

Population

60 adults (>18 years) in Uzbekistan with type 2 diabetes mellitus and diabetic nephropathy (CKD stage 5D) on maintenance hemodialysis for at least 3 months, free of recent acute coronary syndrome or decompensated heart failure.

E

Exposure

Poor glycemic control defined as glycated hemoglobin (HbA1c) ≥7.0% (n=34)

C

Comparator

Adequate glycemic control defined as glycated hemoglobin (HbA1c) <7.0% (n=26); both groups received standard bicarbonate-based hemodialysis therapy three times weekly

O

Outcome

N-terminal pro-brain natriuretic peptide (NT-proBNP) levels as a biomarker of myocardial stresssurrogate

Main Result

Odds Ratio: 1.45 (95% CI 1.02–2.05)

Absolute Event Rate: 628.3% vs 549.5%

p-value: p=0.04

In patients with type 2 diabetes undergoing maintenance hemodialysis, poor glycemic control (HbA1c ≥7.0%) is independently associated with elevated NT-proBNP levels even before overt echocardiographic structural remodeling occurs, supporting the combined use of HbA1c and NT-proBNP for cardiovascular risk stratification.

Limitations

Cross-sectional, single-center design precludes causal inference and limits generalizability
Relatively modest sample size (n=60) for multivariable logistic regression, resulting in limited precision
Multiple between-group comparisons performed without formal correction for multiplicity
Conventional echocardiographic parameters may lack sensitivity to detect early diastolic dysfunction compared to tissue Doppler indices or global longitudinal strain
Residual confounding by dialysis-related factors (interdialytic weight gain, timing of blood sampling, dialysis adequacy, erythropoiesis-stimulating agent dosage) could not be fully excluded
Relatively modest sample size (n=60) for multivariable logistic regression, with the lower bound of the confidence interval approaching unity
Multiple between-group comparisons were performed without formal correction for multiplicity
Conventional echocardiographic parameters (ejection fraction, ventricular volumes) may lack sensitivity to detect early diastolic dysfunction compared to tissue Doppler or global longitudinal strain
Residual confounding by unmeasured dialysis-related factors (interdialytic weight gain, timing of blood sampling, dialysis adequacy, and erythropoiesis-stimulating agent dosage)

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Implication

Should not change practice in T2DM hemodialysis; leaves open whether tighter control lowers NT-proBNP or events.

Abstract

Aim. Patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy undergoing maintenance hemodialysis represent a population at extremely high cardiovascular risk. Chronic hyperglycemia contributes to myocardial injury through inflammation, oxidative stress, endothelial dysfunction, and pathological cardiac remodeling. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-established biomarker of myocardial stress and cardiovascular risk; however, its relationship with glycemic control in patients undergoing hemodialysis remains insufficiently studied. Objective. To assess the relationship between glycemic control and NT-proBNP levels in patients with T2DM and diabetic nephropathy undergoing maintenance hemodialysis. Materials and Methods. This cross-sectional study included 60 patients with T2DM and diabetic nephropathy receiving maintenance hemodialysis (CKD stage 5D). According to glycated hemoglobin (HbA1c) levels, patients were divided into two groups: HbA1c <7.0% (n=26) and HbA1c ≥7.0% (n=34). NT-proBNP levels were assessed and compared between groups. Spearman correlation analysis was used to evaluate the association between HbA1c and NT-proBNP. Logistic regression analysis was performed to identify independent predictors of elevated NT-proBNP. Results. Patients with HbA1c ≥7.0% had significantly higher NT-proBNP levels compared with those with HbA1c <7.0% (628.3 vs. 549.5 pg/mL; p = 0.04). In the subgroup with poor glycemic control, a moderate positive correlation was observed between HbA1c and NT-proBNP (r=0.34; p=0.049). Logistic regression analysis identified HbA1c as an independent predictor of elevated NT-proBNP (OR=1.45; 95% CI 1.02–2.05; p=0.04). Based on these findings, a three-level cardiovascular risk stratification algorithm using HbA1c and NT-proBNP was proposed. Conclusion. Poor glycemic control is associated with elevated NT-proBNP levels in patients with T2DM and diabetic nephropathy undergoing maintenance hemodialysis. HbA1c may serve as an independent predictor of myocardial stress and cardiovascular risk in this population. Combined assessment of HbA1c and NT-proBNP may improve cardiovascular risk stratification and support optimization of treatment strategies.

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Cite This Study

Турғунпулатовна et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus and diabetic nephropathy undergoing maintenance hemodialysis (CKD stage 5D) (n=60). Poor glycemic control (HbA1c ≥7.0%) vs. Adequate glycemic control (HbA1c <7.0%) was evaluated on Elevated NT-proBNP levels (myocardial stress) (OR 1.45, 95% CI 1.02–2.05, p=0.04). Poor glycemic control (HbA1c ≥7.0%) was associated with higher NT-proBNP levels (628.3 vs 549.5 pg/mL; p=0.04) and independently predicted elevated NT-proBNP (OR 1.45; 95% CI 1.02–2.05) in T2DM hemodialysis patients.

synapsesocial.com/papers/6af0e9a6de503f3774140a9d https://doi.org/10.70626/cardiouz-2026-3-00095

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Glycemic Control as a Predictor of Myocardial Stress in Patients with Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Glycemic Control as a Predictor of Myocardial Stress in Patients with Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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