Glycemic Control as a Predictor of Myocardial Stress in Patients with Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis
Received: 2026-07-03
Published: 2026-09-30
Abstract
Aim. Patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy undergoing maintenance hemodialysis represent a population at extremely high cardiovascular risk. Chronic hyperglycemia contributes to myocardial injury through inflammation, oxidative stress, endothelial dysfunction, and pathological cardiac remodeling. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-established biomarker of myocardial stress and cardiovascular risk; however, its relationship with glycemic control in patients undergoing hemodialysis remains insufficiently studied.
Objective. To assess the relationship between glycemic control and NT-proBNP levels in patients with T2DM and diabetic nephropathy undergoing maintenance hemodialysis.
Materials and Methods. This cross-sectional study included 60 patients with T2DM and diabetic nephropathy receiving maintenance hemodialysis (CKD stage 5D). According to glycated hemoglobin (HbA1c) levels, patients were divided into two groups: HbA1c <7.0% (n=26) and HbA1c ≥7.0% (n=34). NT-proBNP levels were assessed and compared between groups. Spearman correlation analysis was used to evaluate the association between HbA1c and NT-proBNP. Logistic regression analysis was performed to identify independent predictors of elevated NT-proBNP.
Results. Patients with HbA1c ≥7.0% had significantly higher NT-proBNP levels compared with those with HbA1c <7.0% (628.3 vs. 549.5 pg/mL; p = 0.04). In the subgroup with poor glycemic control, a moderate positive correlation was observed between HbA1c and NT-proBNP (r=0.34; p=0.049). Logistic regression analysis identified HbA1c as an independent predictor of elevated NT-proBNP (OR=1.45; 95% CI 1.02–2.05; p=0.04). Based on these findings, a three-level cardiovascular risk stratification algorithm using HbA1c and NT-proBNP was proposed.
Conclusion. Poor glycemic control is associated with elevated NT-proBNP levels in patients with T2DM and diabetic nephropathy undergoing maintenance hemodialysis. HbA1c may serve as an independent predictor of myocardial stress and cardiovascular risk in this population. Combined assessment of HbA1c and NT-proBNP may improve cardiovascular risk stratification and support optimization of treatment strategies.
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