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Abstract Background and Aims Glycemic variability, defined as fluctuations in blood glucose levels throughout the day or over longer periods, may contribute to diabetic complications and increased mortality risk beyond persistent hyperglycemia. This study aimed to evaluate glycemic variability, as measured by HbA1c variability, and its association with mortality in patients with diabetes and end-stage kidney disease (ESKD) undergoing maintenance hemodialysis (HD) or peritoneal dialysis (PD). Method Data were extracted from the Swedish Renal Register (SRR). The long-term glycemic variability was quantified as the coefficient of variation (CV) calculated as the ratio of the standard deviation (SD) of individual HbA1c measurements (SD) and the mean value of individual HbA1c measurements i.e. SD(HbA1c)/mean (HbA1c) × 100. After exploring the HbA1c-variability patients were categorized into three groups based on CV ≤4, CV 5–15 and CV ≥15. Associations between HbA1c variability and mortality were assessed using Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI), with adjustments for demographic factors, laboratory findings, and comorbidities. Patients with CV≤4 served as the reference group. Results A total of 1,685 patients with diabetes and ESKD on maintenance dialysis, including 1,360 on HD and 325 on PD, were analyzed. The mean age was 65 ± 13.1 years, and 67% were men. The mean follow-up duration was 3.2 ± 2.4 years, during which 850 deaths (50.4%) were recorded 50% (n = 678) in HD patients and 52% (n = 167) in PD patients. The mean CV HbA1c was higher in HD patients compared to PD patients (13 vs. 11, P 0.001). A CV HbA1c ≥15 was observed in 30% (n = 402) of HD patients and 18% (n = 60) of PD patients (P 0.001). In an adjusted multivariate model, high glycemic variability (CV HbA1c ≥15) was significantly associated with increased mortality risk in both HD (HR = 1.43, 95% CI: 1.12–1.83, P = 0.005) and PD patients (HR = 1.89, 95% CI: 1.13–3.16, P = 0.015). Conclusion Elevated glycemic variability is associated with a higher risk of mortality in patients with diabetes and ESKD undergoing maintenance dialysis. Glycemic variability was significantly greater in HD patients compared to PD patients, with a larger proportion experiencing very high variability. Future research should explore the influence of dialysis modality on glycemic variability and its clinical implications.
Afghahi et al. (Wed,) studied this question.