Adjusted cause-specific mortality rates stratified by serum glycated albumin levels in dialysis patients with diabetes
| GA level | All patients (n=40 417) | Patients taking hypoglycemic agents (n=27 761) | Patients not taking hypoglycemic agents (n=12 656) | Patients with malnutrition taking hypoglycemic agents (n=5467) | ||||
| HR (95% CL) | SHR (95% CL) | HR (95% CL) | SHR (95% CL) | HR (95% CL) | SHR (95% CL) | HR (95% CL) | SHR (95% CL) | |
| Infection-related mortality | ||||||||
| ≤15.8% | 0.93 (0.71, 1.22) | 0.87 (0.66, 1.14) | 0.90 (0.64, 1.28) | 0.94 (0.61, 1.45) | 0.90 (0.64,1.28) | 0.83 (0.58, 1.18) | 1.37 (0.74, 2.57) | 1.31 (0.70, 2.44) |
| 15.9%–17.2% | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 17.3%–18.3% | 1.04 (0.80, 1.34) | 1.02 (0.79, 1.32) | 0.85 (0.59, 1.23) | 1.29 (0.89, 1.86) | 0.85 (0.59, 1.23) | 0.80 (0.55, 1.16) | 1.10 (0.62, 0.96) | 1.15 (0.64, 2.06) |
| 18.4%–19.3% | 1.01 (0.78, 1.31) | 0.97 (0.75, 1.26) | 1.89 (0.61, 1.30) | 1.10 (0.76, 1.59) | 0.89 (0.61, 1.30) | 0.85 (0.58, 1.25) | 1.00 (0.57, 1.76) | 0.94 (0.53, 1.66) |
| 19.4%–20.4% | 1.21 (0.95, 1.54) | 1.20 (0.94, 1.54) | 1.14 (0.80, 1.61) | 1.31 (0.92, 1.85) | 1.14 (0.80, 1.61) | 1.12 (0.79, 1.60) | 0.95 (0.55, 1.65) | 0.92 (0.53, 1.61) |
| 20.5%–21.5% | 1.10 (0.85, 1.42) | 1.12 (0.87, 1.45) | 1.12 (0.75, 1.65) | 1.20 (0.84, 1.71) | 1.12 (0.75, 1.65) | 1.10 (0.75, 1.62) | 0.98 (0.57, 1.66) | 1.04 (0.61, 1.78) |
| 21.6%–22.9% | 1.02 (0.79, 1.31) | 1.02 (0.80, 1.32) | 1.00 (0.67, 1.47) | 1.09 (0.77, 1.55) | 1.00 (0.67, 1.47) | 1.00 (0.68, 1.48) | 1.09 (0.65, 1.83) | 1.06 (0.62, 1.80) |
| 23.0%–24.8% | 1.31 (1.03, 1.67) | 1.24 (0.98, 1.59) | 1.28 (0.87, 1.47) | 1.35 (0.96, 1.88) | 1.28 (0.87, 1.86) | 1.19 (0.82, 1.74) | 1.02 (0.62, 1.70) | 0.97 (0.58, 1.63) |
| 24.9%–28.0% | 1.48 (1.17, 1.87) | 1.41 (1.11, 1.79) | 1.48 (1.01, 2.18) | 1.55 (1.12, 2.15) | 1.48 (1.01, 2.18) | 1.34 (0.89, 2.01) | 1.38 (0.85, 2.25) | 1.31 (0.80, 2.16) |
| >28.0% | 1.48 (1.16, 1.87) | 1.36 (1.07, 1.74) | 1.10 (0.71, 1.72) | 1.56 (1.13, 2.16) | 1.10 (0.71, 1.72) | 1.01 (0.62, 1.64) | 1.55 (0.96, 2.49) | 1.44 (0.89, 2.35) |
| Cardiovascular-related mortality | ||||||||
| ≤15.8% | 1.04 (0.85, 1.28) | 1.02 (0.83, 1.25) | 1.06 (0.80, 1.40) | 1.03 (0.77, 1.38) | 1.06 (0.80, 1.40) | 1.03 (0.78, 1.36) | 1.07 (0.60, 1.92) | 1.04 (0.58, 1.87) |
| 15.9%–17.2% | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 17.3%–18.3% | 1.20 (0.99, 1.45) | 1.20 (0.99, 1.46) | 1.39 (1.05, 1.83) | 1.04 (0.80, 1.36) | 1.39 (1.05, 1.83) | 1.39 (1.05, 1.83) | 0.93 (0.55, 1.58) | 0.99 (0.58, 1.67) |
| 18.4%–19.3% | 1.13 (0.93, 1.38) | 1.14 (0.94, 1.38) | 1.24 (0.92, 1.66) | 1.02 (0.79, 1.32) | 1.24 (0.92, 1.66) | 1.26 (0.94, 1.69) | 1.35 (0.84, 2.18) | 1.38 (0.86, 2.22) |
| 19.4%–20.4% | 1.11 (0.91, 1.34) | 1.10 (0.91, 1.33) | 1.09 (0.81, 1.49) | 1.05 (0.82, 1.34) | 1.09 (0.81, 1.49) | 1.10 (0.81, 1.51) | 0.85 (0.52, 1.40) | 0.86 (0.52, 1.41) |
| 20.5%–21.5% | 1.21 (1.00, 1.47) | 1.22 (1.00, 1.48) | 1.41 (1.03, 1.93) | 1.10 (0.86, 1.40) | 1.41 (1.03, 1.93) | 1.39 (1.01, 1.91) | 1.03 (0.64, 1.65) | 1.13 (0.71, 1.80) |
| 21.6%–22.9% | 1.21 (1.00, 1.46) | 1.21 (1.00, 1.46) | 1.31 (0.95, 1.79) | 1.09 (0.86, 1.39) | 1.31 (0.95, 1.79) | 1.34 (0.98, 1.84) | 1.03 (0.65, 1.65) | 1.03 (0.65, 1.65) |
| 23.0%–24.8% | 1.26 (1.04, 1.51) | 1.21 (1.00, 1.46) | 1.39 (1.00, 1.92) | 1.12 (0.88, 1.41) | 1.39 (1.00, 1.92) | 1.31 (0.94, 1.82) | 1.16 (0.74, 1.82) | 1.17 (0.75, 1.82) |
| 24.9%–28.0% | 1.32 (1.09, 1.60) | 1.27 (1.05, 1.53) | 1.51 (1.07, 2.13) | 1.15 (0.91, 1.46) | 1.51 (1.07, 2.13) | 1.41 (0.99, 2.01) | 1.27 (0.82, 1.98) | 1.23 (0.79, 1.92) |
| >28.0% | 1.62 (1.35, 1.95) | 1.50 (1.24, 1.81) | 1.93 (1.35, 2.76) | 1.37 (1.09, 1.73) | 1.93 (1.35, 2.76) | 1.76 (1.22, 2.55) | 1.52 (0.99, 2.34) | 1.40 (0.92, 2.15) |
| Cancer-related mortality | ||||||||
| ≤15.8% | 1.30 (0.89, 1.90) | 1.27 (0.87, 1.85) | 1.63 (1.00, 2.66) | 0.80 (0.42, 1.55) | 1.63 (1.00, 2.66) | 1.64 (1.00, 2.68) | 0.56 (0.17, 1.84) | 0.56 (0.17, 1.86) |
| 15.9%–17.2% | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 17.3%–18.3% | 1.09 (0.74, 1.61) | 1.08 (0.74, 1.60) | 1.09 (0.63, 1.89) | 1.09 (0.63, 1.89) | 1.09 (0.63, 1.89) | 1.09 (0.63, 1.89) | 1.07 (0.44, 2.60) | 1.14 (0.46, 2.81) |
| 18.4%–19.3% | 1.07 (0.73, 1.58) | 1.05 (0.71, 1.55) | 1.14 (0.65, 2.00) | 0.98 (0.57, 1.69) | 1.14 (0.65, 2.00) | 1.16 (0.66, 2.03) | 0.61 (0.23, 1.60) | 0.61 (0.23, 1.58) |
| 19.4%–20.4% | 1.09 (0.75, 1.59) | 1.08 (0.74, 1.58) | 0.80 (0.43, 1.49) | 1.27 (0.77, 2.09) | 0.80 (0.43, 1.49) | 0.81 (0.43, 1.53) | 0.75 (0.31, 1.82) | 0.74 (0.30, 1.81) |
| 20.5%–21.5% | 0.84 (0.55, 1.27) | 0.83 (0.55, 1.27) | 0.44 (0.18, 1.07) | 1.00 (0.59, 1.69) | 0.44 (0.18, 1.07) | 0.43 (0.17, 1.05) | 0.86 (0.37, 1.99) | 0.90 (0.39, 2.08) |
| 21.6%–22.9% | 1.14 (0.78, 1.66) | 1.14 (0.78, 1.66) | 1.16 (0.63, 2.12) | 1.11 (0.67, 1.84) | 1.16 (0.63, 2.12) | 1.21 (0.66, 2.24) | 0.64 (0.26, 1.55) | 0.62 (0.26, 1.47) |
| 23.0%–24.8% | 1.08 (0.74, 1.58) | 1.08 (0.74, 1.58) | 1.35 (0.73, 2.49) | 1.03 (0.62, 1.70) | 1.35 (0.73, 2.49) | 1.25 (0.67, 2.34) | 0.96 (0.43, 2.12) | 0.93 (0.43, 2.05) |
| 24.9%–28.0% | 1.06 (0.72, 1.57) | 1.06 (0.72, 1.57) | 1.28 (0.65, 2.52) | 1.05 (0.64, 1.74) | 1.28 (0.65, 2.52) | 1.16 (0.57, 2.34) | 0.84 (0.37, 1.91) | 0.78 (0.35, 1.76) |
| >28.0% | 0.89 (0.59, 1.35) | 0.89 (0.59, 1.35) | 1.19 (0.56, 2.50) | 0.84 (0.50, 1.41) | 1.19 (0.56, 2.50) | 1.12 (0.52, 2.43) | 0.61 (0.26, 1.42) | 0.54 (0.24, 1.22) |
The adjusted baseline variables were as follows: age, sex, vintage, dialysis modality, body mass index, smoking, vascular complications, hypoglycemic drug use, antihypertensive drug use, hemoglobin, albumin, C-reactive protein, Kt/V, the normalized protein catabolic rate, high-density cholesterol, calcium, phosphate, and parathyroid hormone.
Hypoglycemic agents included insulin, dipeptidyl peptidase-4 inhibitor (DPP4i), and oral hypoglycemic agents (OHAs). The Global Leadership Initiative on Malnutrition (GLIM) criteria (serum albumin <3.8 g/dL and a low body mass index (<18.5 if <70 years old and <20 if ≥70 years old) or more than 10% weight loss through 2013–2014) were used to assess malnutrition.12
CL, confidence limits; GA, glycated albumin; HR, Hazard ratio; SHR, subdistribution HR.