Glycemic Management in ESRD and Earlier Stages of CKD

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Glycemic Management in ESRD and Earlier Stages of CKD Mark E. Williams, MD, Rajesh Garg, MD American Journal of Kidney Diseases Volume 63, Issue 2, Pages S22-S38 (February 2014) DOI: 10.1053/j.ajkd.2013.10.049 Copyright © 2014 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 Overview of glucose/insulin homeostasis in chronic kidney disease. Disturbances of glucose metabolism include insulin resistance and glucose intolerance. Several factors contribute to hyperglycemia, which may coexist with hypoglycemia. Adapted with permission of the National Kidney Foundation from Kovesdy et al.134 American Journal of Kidney Diseases 2014 63, S22-S38DOI: (10.1053/j.ajkd.2013.10.049) Copyright © 2014 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 Relation between glycemic control and hemodialysis survival in 24,875 hemodialysis patients with a follow-up of 3 years, using time-dependent survival models with repeated measures and multiple case-mix adjustments. Data were collected at baseline and every quarter to a maximum of 3 years’ follow-up. Extremes of glycemia were associated weakly with survival in the study population. ∗P=0.001; †P=0.05. Abbreviation: HbA1c, glycated hemoglobin. Reproduced with permission of the American Society of Nephrology from Williams et al.53 American Journal of Kidney Diseases 2014 63, S22-S38DOI: (10.1053/j.ajkd.2013.10.049) Copyright © 2014 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Relationship between longitudinal measurements of glycated albumin and hospitalization rates within 17 days of the measurement in 444 patients with end-stage renal disease and diabetes mellitus (presented by quintile). Higher glycated albumin rates were associated with increased hospitalization and, in a best-fit model, with poorer survival (data not shown). Reproduced with permission of the American Society of Nephrology from Freedman et al.62 American Journal of Kidney Diseases 2014 63, S22-S38DOI: (10.1053/j.ajkd.2013.10.049) Copyright © 2014 National Kidney Foundation, Inc. Terms and Conditions