Impaired fasting glucose is comparable to diabetes mellitus in predicting mortality and cardiovascular events in patients undergoing peritoneal dialysis: the role of β-cell function and insulin resistance.

چکیده اصلی

Peritoneal dialysis (PD) disrupts glucose metabolism due to repeated exposure to glucose-based dialysate. This prospective cohort study evaluates whether impaired fasting glucose (IFG) confers cardiovascular and mortality risks comparable to those of diabetes mellitus (DM) and to analyze the contributions of β-cell dysfunction and insulin resistance (IR) in patients undergoing PD. 216 patients receiving PD in Taiwan were stratified by baseline glycemic status into normal fasting glucose (n = 71), IFG (n = 58), and DM (n = 87). β-cell function was assessed using the Homeostasis Model Assessment of β-cell Function (HOMA-β), while IR was evaluated using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and the triglyceride-glucose (TyG) index. The primary outcomes were all-cause mortality and 3-point major adverse cardiovascular events (3 P-MACE). Over a median follow-up of 41 months, 69 deaths (32%) occurred; 42% and 38% were attributed to cardiovascular and infectious causes, respectively. Survival curves for IFG and DM were nearly superimposable, and both were worse than that for normal glucose. In fully adjusted models, IFG independently predicted 3 P-MACE (sHR, 4.00; 95% CI, 1.50-10.66; p = 0.006) and all-cause mortality (HR, 2.48; 95% CI, 1.16-5.32; p = 0.02), with risks comparable to those observed in DM. The TyG index independently predicted both outcomes, whereas greater β-cell function was associated with a reduced risk of both endpoints. These findings suggest that cardiovascular and mortality risks in IFG are comparable to those in DM among PD patients, potentially mediated by β-cell dysfunction and increased IR.

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