ASSOCIATION OF HIGH HBA1C WITH INTERDIALYTIC WEIGHT GAIN IN DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS

 

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ASSOCIATION OF HIGH HBA1C WITH INTERDIALYTIC WEIGHT GAIN IN DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS

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Md. Nazrul
Islam
Md. Nazrul Islam nazrul.rita@gmail.com Dhaka Medical College, Dhaka Nephrology Dhaka Bangladesh *
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Chronic kidney disease (CKD) is a progressive loss of kidney

function over months or years. The majority of CKD patients ultimately

reach ESRD and need RRT. Hemodialysis is one of the treatment options for

end-stage renal disease (ESRD). Excessive fluid gain between hemodialysis

sessions is one crucial factor associated with hypertension and shortened

survival for patients. In addition, excessive weight gain between hemodialysis

predisposes to an increase in the risk of intradialytic hypotension or morbidity

due to corresponding increased ultrafiltration rates when the duration

of dialysis sessions cannot be extended. Many studies have shown that

increased IDWG is associated with increased glycosylated hemoglobin. The

glycosylated hemoglobin (HbA1c) test has been the most widely accepted,

reliable biomarker for evaluating long-term glycemic control in patients with

diabetes mellitus. Diabetic patients on MHD have increased thirst, and a

recent multi-center study showed that they were more likely to have more

significant interdialytic weight gain than nondiabetic patients. Aim of the

study: To determine the association between interdialytic weight gain and

glycosylated hemoglobin in diabetic patients on maintenance hemodialysis.

This hospital-based prospective analytical study was conducted

at the Department of Nephrology, Dhaka Medical College. A total of

109 diabetic patients with MHD were included in this study according

to selection criteria. HbA1c was determined for each patient. IDWG was

calculated from two weights measured between two dialysis sessions. A

pretested questionnaire was used for the interview. Informed written consent

was obtained. Seventeen patients were dropped out, so, finally, data were

analyzed for 92 patients. ANOVA, Student's t-test, and Chi-squared test were

carried out. Following the completion of data collection, data were analyzed

using SPSS version 26.

The mean age of the patients was 45.86±14.10 years, ranging from

23-78 years. Males (65.2%) were predominant than females (34.8%). Male

to female ratio was 1.88:1. HbA1c level was significantly elevated as age

increased (p=0.037). Sixty-one (66.3%) patients had interdialytic weight gain.

Mean weight gain was 2.88±1.04 kg, ranging from 0.6 kg to 4.67 kg. Among

the study subjects, 15.2%, 30.4%, and 54.3% had HbA1c ≤6%, 6.1-7.9%, and

≥8%, respectively. A significant (p=0.023) association was observed. HbA1c

was elevated as the increment of IDWG. There was a significant positive

correlation between HbA1c and IDWG (r=0.365; p<0.001). Interdialytic

weight gain decreased as per increment of the duration of dialysis. There was

a significant negative correlation between interdialytic weight gain and the

duration of dialysis (r= -0.382; p<0.001).

The results of this study demonstrated that interdialytic weight

gain (IDWG) is positively correlated with high HbA1c and inversely related

to the duration of dialysis.

Kewords