Glycemic variability and all-cause mortality in patients with diabetes receiving hemodialysis: A prospective cohort study

We aimed to examine the possible association between glycemic variability (GV) and all-cause mortality in patients with diabetes receiving hemodialysis.We conducted a prospective longitudinal cohort study of patients with diabetes mellitus undergoing hemodialysis at the Jiaxing Hemodialysis Center between December 2012 and December 2018. GV quantified with coefficient of variation (CV). The endpoint in the current study was defined as all-cause mortality.Of 1240 patients included in the analyses, there were 340 (27.4%) patients with death from all causes during a median follow-up time of 2.4 years (range 0-3.0). In a Kaplan-Meier analysis, cumulative survival was significantly dependent on CV quartiles with an apparent dose-response (log-rank P < 0.001). In a multiple Cox regression model, the highest CV quartile was independently associated with increased risk of all-cause mortality (HR 1.887, 95% CI 1.407-2.531, P < 0.001).Higher GV is associated with increased mortality risk among patients with diabetes receiving hemodialysis. Future studies are needed to explore whether decreasing GV would be associated with reduced risk of mortality.