Glycaemic control and complications in haemodialysis patients: the TURK-HEMODIAB Study.
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Gungor Ozkan, Korucu Berfu, Oguz Ebru Gok, Eren Necmi, Ural Zeynep, Dheir Hamad, Tatar Erhan, Inci Ayca, Kocyigit Ismail, Aydin Zeki, Ulutas Ozkan, Kara Ekrem, Altunoren Orcun, Yilmaz Zulfukar, Sevinc Mustafa, Sevinc Can, Surardamar Atalay, Islam Mahmud, Akgol Cuneyt, Tonbul Halil Zeki, Ozler Tuba Elif, Guney Ibrahim, Cevher Simal Koksal, Uysal Cihan, Guzel Fatma Betul, Mutluay Ruya, Ercan Zafer, Sirali Semahat Karahisar, Cankaya Emre, Onan Engin, Candan Ferhan, Eroglu Eray, Tezcan Neslihan, Polat Mehmet, Huzmeli Can, Ozkurt Sultan, Akagun Tulin, Alp Pinar, Ozelsancak Ruya, Yurteri Gurkan, Tanrisev Mehmet, Ilter Ali, Guvercin Beyhan, Demir Mehmet Emin, Tomar Ozdem Kavraz, Azak Alper, Turgut Faruk Hilmi, Tuncay Mehmet, Akdam Hakan, Selen Tamer, Yilmaz Fatih, Danis Ramazan, Eyupoglu Sahin, Kumru Gizem, Demir Simge Bardak, Alagoz Selma, Uzun Sami, Ozdemir Orhan, Adibelli Zelal, Polat Mehmet, Ulu Ramazan, Murt Ahmet, Dolarslan Murside Esra, Bal Ayse Zeynep, Ayar Yavuz, Sensoy Nazife Nur Ozer, Sezen Mehmet, Sahutoglu Tuncay, Kara Ali Veysel, Turkmen Ercan, Kayabasi Hasan, Gorgulu Numan, Hur Ender, Yucel Fatma Sibel Kocak, Eren Zehra, Sahin Garip, Kasapoglu Umut, Biyik Zeynep, Koyuncu Sumeyra, Aydin Mehmet Fetullah, Yildirim Tolga, Kuzgun Gulsah Sasak, Ustundag Sedat, Celik Abdulkadir, Akcali Esra, Usalan Ozlem, Kaya Bulent, Altiparmak Mehmet Riza, Tugcu Murat, Olmaz Refik, Erkus Edip, Soypacaci Zeki, Zorba Belma Gokcen, Yavuz Demet, Oztop Kenan Evren, Ogutmen Melike Betul, Harmankaya Ozlem, Taymez Dilek Guven, Kaptanogullari Hakan, Magden Kemal, Seyrek Neslihan, Berktas Haci Bayram, Erdem Mehmet, Ozturk Savas, Arikan Izzet Hakki, Kutlay Sim, Altun Bulent, Ates Kenan, Arici Mustafa
Аннотация
METHODS: A total of 16 043 patients were screened in 253 dialysis centres in Turkey and 5038 diabetic HD patients were included in the study. At participating centres, patients' diabetes history, complications, medications, haemoglobin A1c (HbA1c) and other laboratory data were reviewed and recorded by nephrologists.
RESULTS: The average age of the patients was 64.0 ± 11.2 years and 56% were male. The mean HbA1c was 7.4 ± 1.5%. Patients were divided into three groups according to the HbA1c level (<6.5%, 6.5-8% and >8%). As the HbA1c levels increased, the mean systolic blood pressure and diastolic blood pressure increased significantly. In addition, as the HbA1c levels increased, the number of patients with coronary artery disease, patients undergoing coronary artery bypass graft surgery and the rate of patients with diabetic retinopathy and vision loss increased. Diabetic foot disease and amputation rates were also higher in the group with poor glycaemic control. The number of patients using intensive or mixed insulin was also higher in the group with high HbA1c levels. In ordinal logistic regression analysis, age significantly decreased and higher body mass index slightly increased the risk of a higher HbA1c. Also, the need for a diabetic diet was greater in those with high HbA1c levels.
CONCLUSION: Our study highlights that the target values for diabetic HD patients in Turkey are partially compatible with the 2022 Kidney Disease: Improving Global Outcomes guidelines for diabetes management. Nevertheless, more effort and teamwork are needed to improve patient outcomes.