Association of High HbA1c with Interdialytic Weight Gain in Diabetic Patients on Maintenance Hemodialysis

Author(s): Dr. Md. Saeed Hossain, Professor Dr. Md. Nazrul Islam, Dr. Md. Safayet Hossain Pramanik, Dr. Md. Abdul Hakim, Dr. Md. Tamim Aziz, Dr. Md. Shoriful Islam

Background: Chronic kidney disease (CKD) is a progressive loss of kidney function over months or years. The majority of CKD patients ultimately reach ESRD and need RRT. Hemodialysis is one of the treatment options for end-stage renal disease (ESRD). Excessive fluid gain between hemodialysis sessions is one crucial factor associated with hypertension and shortened survival for patients. In addition, excessive weight gain between hemodialysis predisposes to an increase in the risk of intradialytic hypotension or morbidity due to corresponding increased ultrafiltration rates when the duration of dialysis sessions cannot be extended. Many studies have shown that increased IDWG is associated with increased glycosylated hemoglobin. The glycosylated hemoglobin (HbA1c) test has been the most widely accepted, reliable biomarker for evaluating long-term glycemic control in patients with diabetes mellitus. Diabetic patients on MHD have increased thirst, and a recent multi-center study showed that they were more likely to have more significant interdialytic weight gain than nondiabetic patients. Aim of the study: To determine the association between interdialytic weight gain and glycosylated hemoglobin in diabetic patients on maintenance hemodialysis. Methods: This hospital-based prospective analytical study was conducted at the Department of Nephrology, Dhaka Medical College. A total of 109 diabetic patients with MHD were included in this study according to selection criteria. HbA1c was determined for each patient. IDWG was calculated from two weights measured between two dialysis sessions. A pretested questionnaire was used for the interview. Informed written consent was obtained. Seventeen patients were dropped out, so, finally, data were analyzed for 92 patients. ANOVA, Student's t-test, and Chi-squared test were carried out. Following the completion of data collection, data were analyzed using SPSS version 26. Result: The mean age of the patients was 45.86±14.10 years, ranging from 23-78 years. Males (65.2%) were predominant than females (34.8%). Male to female ratio was 1.88:1. HbA1c level was significantly elevated as age increased (p=0.037). Sixty-one (66.3%) patients had interdialytic weight gain. Mean weight gain was 2.88±1.04 kg, ranging from 0.6 kg to 4.67 kg. Among the study subjects, 15.2%, 30.4%, and 54.3% had HbA1c ≤6%, 6.1-7.9%, and ≥8%, respectively. A significant (p=0.023) association was observed. HbA1c was elevated as the increment of IDWG. There was a significant positive correlation between HbA1c and IDWG (r=0.365; p<0.001). Interdialytic weight gain decreased as per increment of the duration of dialysis. There was a significant negative correlation between interdialytic weight gain and the duration of dialysis (r= -0.382; p<0.001). Conclusion: The results of this study demonstrated that interdialytic weight gain (IDWG) is positively correlated with high HbA1c and inversely related to the duration of dialysis.