Uncontrolled Diabetes is a Strong Predictor of Amputation in End Stage Renal Disease Patients on Hemodialysis

Background: Diabetic nephropathy remains a strong risk factor for chronic kidney disease progression. Hemoglobin A1C (HBA1C) has historically been used as a marker for complications related to diabetes. The purpose of this study is to examine the relationship between HBA1C and clinical complications in a patient population with end stage renal disease. Methods: This was a prospective study performed using patients from multiple outpatient dialysis centers in Texas, United States. All patients included patients must have end stage renal disease and were receiving either hemodialysis or peritoneal dialysis. An HBA1C ≥ 6.5% was used as a cutoff to differentiate patients with well controlled versus uncontrolled diabetes in this population. Results: HBA1C ≥ 6.5% was strongly associated with both minor (P = 0.0014) and major (P = 0.006)amputation. Patients with HBA1C ≥ 6.5% was associated with lower mortality compared to patients with HBA1C < 6.5%, P = 0.007. Conclusions: HBA1C remains a reliable marker for amputation in patients with end-stage renal disease; however, there is skepticism in using HBA1C as a marker for survival in these patients.