The Relationship Between The Ratio Of Fasting Plasma Glucose To Hemoglobin A1c And Mortality In Peritoneal Dialysis Patients

BackgroundAbnormal glucose metabolism is an independent risk factor for the mortality of peritoneal dialysis(PD)patients.As main indicators for evaluating glucose metabolism disorders,fasting plasma glucose(FPG)and hemoglobin A1c(Hb A1c)are related with the mortality of diabetic and non-diabetic patients.The use of FPG or HbA1c alone is susceptible to individual differences,but the combination of the two(FPG/Hb A1c)reduces individual differences,which could be applied to predict all-cause mortality in the general population relatively accurately.Up to now,the literature about the relationship between FPG/HbA1c and mortality in PD patients has not been reported.ObjectiveThis study aims to investigate the relationship between FPG/HbA1c and mortality in PD patients by a multicenter retrospective analysis.MethodsThis study included 1278 patients from two PD centers in China from January 1,2009 to October 31,2017.Patients were divided into two groups according to the cutoff FPG/Hb A1c=2.70(Group1,FPG/Hb A1c≤2.70,Group2,FPG/Hb A1c> 2.70).Kaplan-Meier cumulative survival curve and multivariable Cox regression analysis were used to determine the relationship between FPG/HbA1c and the mortality of PD patients,while competitive risk model was applied to assess the effects of other outcomes on the mortality.Moreover,the association between FPG/HbA1c and the mortality was investigated in different subgroups to determine whether there were differences.In order to compare the patients in two groups reasonably,the results of cumulative survival curve and multivariable Cox regression were again verified after 1: 4 propensity score matching(PSM).ResultsDuring follow-up,300 PD patients died.The survival curve suggested that the all-cause mortality of PD patients in the high FPG/HbA1c group was higher than that in the low FPG/HbA1c group(P <0.001).Multivariable Cox regression analysis indicated that the increasing FPG/HbA1c was an independent risk factor for all-cause mortality(HR1.34,95% CI 1.00-1.79,P = 0.049).Competitive risk models showed that all-cause mortality was not influenced by other outcome events(P=0.007).In the subgroup analysis,the mortality of male PD patients in low FPG/HbA1c group was lower than that in high FPG/HbA1c group(P <0.001).The result after PSM was consistent with the above results.ConclusionHigh FPG/HbA1c was an independent risk factor for all-cause mortality in male PD patients.