Study explores benefits, risks of aggressive blood sugar control in hemodialysis patients

Aggressive blood sugar control does not improve survival in diabetic patients with kidney failure, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that physicians should individualize blood sugar targets for these patients and not rely on recommendations based on studies in the general population.

Uncontrolled blood sugar levels can cause serious health problems for diabetic patients with kidney failure; however, studies provide conflicting results on the benefits and risks of aggressive blood sugar control in these individuals.

By studying 24,875 dialysis patients for a maximum of three years of follow-up, Mark Williams, MD (Joslin Diabetes Center) and his colleagues found that only sustained extremes—either high or low—in blood sugar levels increased patients' risk of dying prematurely. Type 2 diabetes patients with hemoglobin A1c levels (a measure of average blood sugar levels) greater 11.0% were particularly at risk, with a 21% increased likelihood of dying during the study. In the small (5.5%) subgroup of patients with type 1 diabetes, those with hemoglobin A1c levels greater than 9% had a 52% increased risk of dying during the study.

"In the absence of randomized, controlled trials, these results suggest that aggressive [blood sugar] control cannot be routinely recommended for all diabetic hemodialysis patients on the basis of reducing mortality risk," the authors concluded. They encouraged physicians who treat diabetic patients with kidney failure to individualize blood sugar targets based on the potential risks and benefits for each patient.