{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T19:22:12Z","timestamp":1772220132017,"version":"3.50.1"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis.<\/jats:p>\n <\/jats:sec>\n \n Methodology<\/jats:title>\n A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control were considered when glycated hemoglobin (HbA1c) levels were <\u2009 6% or >\u20098%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value <\u20090.05 was considered statistically significant.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c <\u20096% and 28.33% had HbA1c >\u20098%. A high risk of HbA1c >\u20098% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06\u20134.41) p =\u2009 0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02\u20132.48) p =\u2009 0.040). The lower risk of HbA1c <\u20096% was observed in patients dialyzed using glucose-containing dialysates than those dialyzed with glucose-free dialysate (0.57 (95% CI 0.36\u20130.87) p =\u2009 0.020).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The high prevalence of poor glycemic control among diabetic CKD patients, as revealed by this study, has significant implications. Patients on antidiabetic medication and those with less than three dialysis sessions per week are at a high risk of HbA1c >\u20098%. Conversely, patients dialyzed using glucose-free dialysates are at a high risk of HbA1c <\u20096%.<\/jats:p>\n Glycemic control in diabetic chronic kidney disease (CKD) patients is a great challenge due to altered glucose homeostasis, gluconeogenesis, tubular glucose reabsorption and inaccuracy of glycemic regulation metrics [1]. Furthermore, changed renal pharmacokinetics of antihyperglycemic agents (AHA), uremic milieu, and dialysis therapy also contribute to this challenge [2]. Based on the severe risk of hyperglycemia and hypoglycemia in patients with diabetic end-stage renal disease (ESRD), glycemic control is of paramount importance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0306357","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T13:39:32Z","timestamp":1739194772000},"page":"e0306357","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and determinants of poor glycemic control among diabetic chronic kidney disease patients on maintenance hemodialysis in Tanzania"],"prefix":"10.1371","volume":"20","author":[{"given":"Emmanuel Arthur","family":"Mfundo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alphonce Ignace","family":"Marealle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goodluck G.","family":"Nyondo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6118-1560","authenticated-orcid":true,"given":"Martine A.","family":"Manguzu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deus","family":"Buma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Kunambi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8963-4920","authenticated-orcid":true,"given":"Ritah F.","family":"Mutagonda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"pone.0306357.ref001","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-022-02316-1","article-title":"Assessment of glycemia in chronic kidney disease","volume":"20","author":"M Hassanein","year":"2022","journal-title":"BMC Med"},{"issue":"2","key":"pone.0306357.ref002","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/sdi.12198","article-title":"Updates on the management of diabetes in dialysis patients","volume":"27","author":"CM Rhee","year":"2014","journal-title":"Semin Dial"},{"issue":"2","key":"pone.0306357.ref003","first-page":"47","article-title":"Management of type 2 diabetes in patients with chronic kidney disease","volume":"3","author":"B Bansal","year":"2017","journal-title":"Arch Clin Nephrol"},{"issue":"7","key":"pone.0306357.ref004","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.2337\/dc05-1887","article-title":"Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study","volume":"29","author":"T Oomichi","year":"2006","journal-title":"Diabetes Care"},{"issue":"8","key":"pone.0306357.ref005","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1681\/ASN.2016121372","article-title":"Therapeutic considerations for antihyperglycemic agents in diabetic kidney disease","volume":"28","author":"JJ Neumiller","year":"2017","journal-title":"J Am Soc Nephrol"},{"issue":"1","key":"pone.0306357.ref006","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.diabres.2005.03.024","article-title":"Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study)","volume":"70","author":"SB Harris","year":"2005","journal-title":"Diabetes Res Clin Pract"},{"key":"pone.0306357.ref007","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2147\/DHPS.S68786","article-title":"Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam","volume":"6","author":"AR Kamuhabwa","year":"2014","journal-title":"Drug Healthc Patient Saf"},{"key":"pone.0306357.ref008","doi-asserted-by":"crossref","first-page":"252","DOI":"10.11604\/pamj.2014.17.252.2972","article-title":"Adherence to anti-diabetic drugs among patients with type 2 diabetes mellitus at Muhimbili National Hospital, Dar es Salaam, Tanzania - 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