Glycosylated hemoglobin levels are associated with cardiovascular events in nondiabetic peritoneal dialysis patients

Background: High glycosylated hemoglobin (HbA(1c)) levels are recognized as a risk factor for cardiovascular disease in the diabetic dialysis population. However, it is not known whether this also applies to nondiabetic dialysis patients. We prospectively investigated the association between HbA(1c) levels and new cardiovascular events in nondiabetic patients treated with peritoneal dialysis. Methods: Eighty nondiabetic patients who had been on peritoneal dialysis treatment were prospectively followed for 5 years. HbA(1c) levels were measured at baseline and every 3 months. Fatal and nonfatal cardiovascular events were assessed during the follow-up. Results: Mean age was 48.5 +/- 15.2 years; 51% were male. Baseline HbA(1c) level was 5.46% +/- 0.41% (range 4.6%-6.3%). Mean HbA(1c) was 5.44% +/- 0.31% (range 4.8%-6.3%) during the study, and positively correlated with age and high-sensitivity C-reactive protein. Twenty fatal and nonfatal cardiovascular events were observed during a mean 41.8 +/- 7.1 months of follow-up. Event-free survival was better in patients with HbA(1c) levels <5.45%, compared with that for those with HbA(1c) levels >= 5.45% (p=0.01). In crude Cox regression analysis, an increase in HbA(1c) level of 0.1% was associated with a 1.22-fold increase in new cardiovascular events (p=0.007). In Cox analyses, HbA(1c) level was found as a significant predictor of cardiovascular events. Conclusion: HbA(1c) levels predict fatal and nonfatal cardiovascular events in nondiabetic peritoneal dialysis patients.