マナベ　シユン   Manabe Shiyun   眞部　俊    所属   医学部 医学科（東京女子医科大学病院）    職種   講師
言語種別	英語
発表タイトル	Predialysis Causal Blood Glucose Level and Mortality in Diabetic Patients on Hemodialysis: A Nationwide Cohort Study from Japan
会議名	Kidney Week 2024
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Manabe Shun, Seki Momoko, Ushio Yusuke, Kawaguchi Yuki, Kataoka Hiroshi, Abe Masanori, Hanafusa Norio, Hoshino Junichi,
発表年月日	2024/10/25
国名	アメリカ合衆国
開催地 （都市, 国名）	San Diego, USA
開催期間	2024/10/24～2024/10/27
概要	Background Blood glucose level (BGL) is the simplest indicator for glycemic control in diabetic patients; however, it remains unclear which predialysis causal BGL is associated with the lowest mortality in diabetic hemodialysis (HD) patients. We examined the association between predialysis causal BGL and mortality in a cohort from the Japanese Society for Dialysis Therapy. Methods We examined maintenance HD patients with diabetes in December 2018, and followed for 3 years. Patients with insufficient dialysis, those with organ transplantation, those with BGL greater than 401 mg/dL, and those with incomplete records for Hb, Alb, or glycemic control were excluded from the analysis. A total of 104,846 patients (29% female; mean age 68.5±11.5; mean dialysis vintage 5.8±5.0 years) were analyzed. Crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for 3-year mortality after adjusting for 20 potential confounders, including age, sex, dialysis vintage, dialysis modality, vascular complications, smoking, type of diabetes, BMI, use of antihypertensive agents, use of hypoglycemic agents, facility type, Kt/V, nPCR, Hb, Alb, CRP, HDL colesterol, Ca, iP, and PTH. Subgroup analyses were performed in patients with serum Alb <3.5 g/dL and those with malnutritional status by the criteria of Global Leadership Initiative on Malnutrition (GLIM). Results We found an U-shaped association between 3-year adjusted mortality and predialysis causal BGLs of ≥141-160 mg/dL [HR 1.10 (1.03-1.17)] and ≥161-180 mg/dL [HR 1.14 (1.06-1.21)], respectively, with the lowest mortality at BGLs of 101-120 mg/dL. Similar U-shaped associations were observed in the sensitivity analyses for patients with malnutritional status, though this trend flattened in these patients. In addition, the adjusted HRs were significantly higher at BGLs of 161-180 mg/dL in patients with low serum Alb (<3.5 mg/dL) [HR 1.11 (1.02-1.22)], and in those with GLIM criteria [HR 1.17 (1.03-1.32)]. Conclusion Predialysis causal BGL was significantly associated with 3-year mortality in diabetic HD patients. In patients with malnutritional status, such as those with serum Alb < 3.5 mg/dL or those with GLIM criteria, a BGL cutoff of 161-180 mg/dL may represent a promising target for glycemic control in these patients.