Glycemic status in diabetic and nondiabetic ESRD Patients with or without hemodialysis in rural hospital of Central Maharashtra

Abstract

Background: Diabetes is a potent cardiovascular risk factor in the general population as well as in people with end-stage renal disease (ESRD) undergoing maintenance dialysis treatment. Previous observational studies have yielded inconsistent results regarding the association between glycemic controls in patients receiving maintenance hemodialysis (MHD). Studies provide evidence that very poor glycemic control is associated with higher mortality in dialysis patients. The significance of the levels of glycosylated haemoglobin in non-diabetic patients with renal disease receiving maintenance hemodialysis remains unclear at the present time. The knowledge of HbA1c in patients with renal diseases could be important in assessing the overall prognosis in such patients and it also has implications in the assessment of their glycaemic status and in preventing post-dialysis morbidity and mortality. Aims & Objective: (1) To study the role of HbA1c as a marker of glycemic status in patients of kidney disease with or without MHD. (2) To compare the utility of fasting glucose level and HbA1c in accessing glycemic status and their relationship. Material and Methods: Study was conducted in the AVBRH, Jawaharlal Nehru medical college, Sawangi (M) Wardha by department of Biochemistry in collaboration with Department of Medicine. 30 patients undergoing maintenance hemodialysis and 30 patients of kidney diseases who are not undergoing MHD, has been taken from ABVRH Sawngi (Meghe). 30 age and sex matched healthy controls were also included in the study. 5.0 ml of blood has been collected from each subject after informed consent .Different parameters such as HbA1c, Fasting and random blood glucose, Urea creatinine, sodium potassium were evaluated in all the groups. Results: Maximum numbers of patients were from age group of 21–40 years. Commonest mode of HIV was heterosexual route (80 %). Male: Female ratio was 4:1. Most of the patients (45.71%) were labour workers, followed by housewife (20%), sales man (18%), textile worker (8.8%), and transport driver (8.8%). Fever (75.71%), weight loss (68.57%) and decrease appetite (65.57%) were predominant symptoms. Pulmonary TB (PTB) was found in 24.28% patients, while extra-pulmonary TB (EPTB) in 75.72% patients. Most of Pulmonary TB had CD 4 count > 180, while in extra-pulmonary TB most of patients had CD 4 count < 180. Commonest form of EPTB was disseminated TB (30%) followed by abdominal TB (21.42%), tuberculous lymphadenopathy (12.85%) and CNS tuberculosis (4.28%). Positive smear for acid-fast bacilli (AFB) was found in 17.14% patients of PTB. The mean CD4 count at presentation were 214 cells/μl, 182.47 cells/μl, 175.22 cells/μl and 54.66 cells/μl in tubercular meningitis, abdominal TB, tuberculosis lymph node TB and disseminated TB respectively. Conclusion: In Non-diabetic patients with ESRD undergoing hemodialysis HbA1c may be used as a marker of impaired glucose metabolism and glycemic c