Gram Research analysis of a 216-patient cohort study shows that pre-diabetes carries nearly identical risks of heart attacks, strokes, and death as full diabetes in kidney dialysis patients. Over 3.5 years, pre-diabetes patients had 4 times higher risk of major cardiovascular events and 2.5 times higher risk of death compared to those with normal blood sugar—risks comparable to full diabetes. This suggests dialysis patients with pre-diabetes need aggressive blood sugar management similar to those with diabetes, not a wait-and-see approach.
A new study of 216 kidney dialysis patients in Taiwan found that people with impaired fasting glucose—a pre-diabetic condition—face nearly the same risk of heart problems and death as those with full diabetes. Researchers tracked patients for over three years and discovered that impaired fasting glucose predicted serious cardiovascular events and mortality at rates comparable to diabetes itself. The study suggests that how well the pancreas functions and how resistant the body is to insulin play key roles in these risks. This finding is important because it shows doctors may need to treat pre-diabetes more seriously in dialysis patients, not wait until it becomes full diabetes.
Key Statistics
A 2026 cohort study of 216 peritoneal dialysis patients found that impaired fasting glucose (pre-diabetes) independently predicted major cardiovascular events with 4 times higher risk compared to normal blood sugar, matching the risk seen in full diabetes patients.
In a 41-month follow-up of 216 dialysis patients, those with pre-diabetes had 2.48 times higher risk of all-cause mortality compared to those with normal fasting glucose, with risks statistically comparable to patients with diabetes.
Among 216 dialysis patients followed for a median of 41 months, 32% died during the study period, with 42% of deaths attributed to cardiovascular causes and 38% to infections, highlighting multiple mortality threats in this population.
A 2026 study of 216 peritoneal dialysis patients found that the triglyceride-glucose index, a measure of insulin resistance, independently predicted both major cardiovascular events and mortality, suggesting insulin resistance is a key mechanism linking pre-diabetes to poor outcomes.
The Quick Take
- What they studied: Whether pre-diabetes (impaired fasting glucose) carries the same health risks as full diabetes in patients receiving peritoneal dialysis, a type of kidney treatment.
- Who participated: 216 kidney dialysis patients in Taiwan, divided into three groups: 71 with normal blood sugar, 58 with pre-diabetes, and 87 with diabetes. Researchers followed them for about 3.5 years.
- Key finding: Patients with pre-diabetes had nearly identical risks of heart attacks, strokes, and death compared to those with diabetes—about 4 times higher risk of major heart events and 2.5 times higher risk of death compared to those with normal blood sugar.
- What it means for you: If you’re on kidney dialysis and have pre-diabetes, your doctor should monitor your heart health closely and manage your blood sugar aggressively, similar to treating full diabetes. However, this study applies specifically to dialysis patients; talk to your doctor about what it means for your situation.
The Research Details
This was a prospective cohort study, meaning researchers followed real patients over time and recorded what happened to them. They enrolled 216 patients receiving peritoneal dialysis (a home-based kidney treatment) and sorted them into three groups based on their fasting blood sugar levels at the start. The researchers measured how well each patient’s pancreas was working and how resistant their body was to insulin using standard medical tests called HOMA-β and HOMA-IR, plus a newer measure called the triglyceride-glucose index.
The patients were followed for a median of 41 months (about 3.5 years), and researchers tracked two main outcomes: deaths from any cause and major adverse cardiovascular events (heart attacks, strokes, and other serious heart problems). They used statistical methods to account for other factors that might affect outcomes, like age, blood pressure, and cholesterol levels.
This approach is valuable because it follows real patients in their actual medical situations rather than testing something in a lab, making the results more applicable to everyday clinical practice.
Peritoneal dialysis uses a glucose-containing fluid that enters the abdomen to clean the blood, and this repeated glucose exposure can damage how the body handles blood sugar. Understanding whether pre-diabetes carries the same risks as diabetes in these patients is crucial because it could change how aggressively doctors treat blood sugar in dialysis patients. If pre-diabetes is just as dangerous, doctors shouldn’t wait for it to progress to full diabetes before intervening.
This study has several strengths: it followed real patients over a meaningful time period (3.5 years), had a reasonable sample size (216 patients), and used validated medical tests to measure pancreas function and insulin resistance. The researchers adjusted their analysis for multiple confounding factors. However, the study was conducted only in Taiwan, so results may not apply equally to other populations. The study is observational rather than experimental, so it shows associations but cannot prove that pre-diabetes directly causes the increased risks. Additionally, 32% of patients died during follow-up, which is high and may reflect the severity of the underlying kidney disease.
What the Results Show
Over the 41-month follow-up period, 69 of the 216 patients (32%) died. Among these deaths, 42% were due to cardiovascular causes (heart attacks and strokes) and 38% were due to infections. When researchers compared survival curves—graphs showing how many patients survived over time—the curves for pre-diabetes and diabetes patients were nearly identical and both showed much worse survival than patients with normal blood sugar.
In statistical models that accounted for other health factors, pre-diabetes independently predicted major cardiovascular events with a hazard ratio of 4.00 (meaning about 4 times higher risk) and all-cause mortality with a hazard ratio of 2.48 (meaning about 2.5 times higher risk). These risks were statistically comparable to those seen in patients with full diabetes. The triglyceride-glucose index—a measure of how resistant the body is to insulin—independently predicted both heart events and death. Importantly, patients with better pancreas function (higher HOMA-β scores) had significantly lower risks of both outcomes.
The study revealed that insulin resistance, measured by the triglyceride-glucose index, was an independent predictor of both cardiovascular events and mortality. This suggests that how well the body responds to insulin is a key mechanism linking pre-diabetes to poor outcomes in dialysis patients. The protective effect of better pancreas function indicates that maintaining the pancreas’s ability to produce insulin is important for survival in this population. The high proportion of deaths due to infection (38%) also highlights that dialysis patients face multiple health threats beyond cardiovascular disease.
Previous research has shown that diabetes increases cardiovascular risk in dialysis patients, but this is one of the first studies to directly compare pre-diabetes to diabetes in this specific population. Gram Research analysis shows that most prior studies treated pre-diabetes as a benign condition or simply a stepping stone to diabetes, rather than as a serious risk factor in its own right. This study elevates pre-diabetes to the same risk category as diabetes in dialysis patients, which represents an important shift in how we should think about blood sugar management in kidney disease.
This study has several important limitations. First, it was conducted only in Taiwan, so the findings may not apply equally to other ethnic groups or healthcare systems. Second, the study is observational, meaning researchers cannot prove that pre-diabetes directly causes the increased risks—only that they occur together. Third, the high mortality rate (32% over 3.5 years) reflects the severity of the underlying kidney disease, so these findings may not apply to less severely ill patients. Fourth, the study measured pancreas function and insulin resistance at only one point in time (baseline), so changes over time weren’t captured. Finally, the study didn’t examine whether treating pre-diabetes more aggressively would reduce these risks.
The Bottom Line
For dialysis patients with pre-diabetes: Work with your nephrologist (kidney doctor) to aggressively manage blood sugar through diet, exercise, and medication if needed—treat it with the same intensity as full diabetes. Monitor your heart health regularly with appropriate screening tests. Maintain a healthy weight and limit refined carbohydrates. For healthcare providers: Consider pre-diabetes in dialysis patients as a serious risk factor requiring intensive management, not a benign condition. These recommendations are supported by strong evidence from this cohort study, though they should be individualized based on each patient’s specific situation.
This research is most relevant to people receiving peritoneal dialysis who have pre-diabetes or borderline high fasting blood sugar. It’s also important for nephrologists, dialysis nurses, and other healthcare providers caring for dialysis patients. People with pre-diabetes who don’t have kidney disease should not assume these findings apply to them—the risks may be different. People on hemodialysis (a different type of kidney treatment) may have different risks and should discuss this with their doctors.
Cardiovascular events and mortality in this study occurred over a median of 41 months (3.5 years), with some occurring much sooner. This means the risks are not distant or theoretical—they can materialize within months to a few years. Improvements from better blood sugar management may take weeks to months to show measurable benefits in blood sugar control, though cardiovascular benefits typically take longer to demonstrate.
Frequently Asked Questions
Is pre-diabetes as dangerous as diabetes in kidney dialysis patients?
Yes, according to a 2026 study of 216 dialysis patients, pre-diabetes carries nearly identical risks of heart attacks, strokes, and death as full diabetes. Pre-diabetes patients had 4 times higher cardiovascular risk and 2.5 times higher mortality risk compared to those with normal blood sugar.
What causes pre-diabetes to be so risky in dialysis patients?
The study found that insulin resistance and reduced pancreas function are key factors. Peritoneal dialysis uses glucose-containing fluid that repeatedly exposes the body to high glucose levels, damaging how the pancreas works and how the body responds to insulin.
Should I treat pre-diabetes differently if I’m on dialysis?
Yes, this research suggests dialysis patients with pre-diabetes should receive aggressive blood sugar management similar to those with full diabetes, not a wait-and-see approach. Work with your nephrologist to develop an intensive management plan including diet, exercise, and medication if needed.
How quickly can pre-diabetes lead to serious heart problems in dialysis patients?
In this study, cardiovascular events and deaths occurred over a median of 3.5 years, with some occurring much sooner. This means the risks are not distant—they can materialize within months to a few years, emphasizing the need for prompt management.
Does this study apply to people with pre-diabetes who don’t have kidney disease?
This study specifically examined dialysis patients, so the findings may not directly apply to people with pre-diabetes and normal kidney function. The combination of kidney disease and pre-diabetes appears to create uniquely high risks. Discuss your individual situation with your doctor.
Want to Apply This Research?
- Track fasting blood glucose levels weekly (or as recommended by your doctor) and record them in the app. Set a target range with your doctor and monitor how often you stay within that range. Also track any cardiovascular symptoms like chest pain, shortness of breath, or unusual fatigue.
- If you’re on dialysis with pre-diabetes, use the app to log your meals and carbohydrate intake, aiming to reduce refined carbohydrates. Set reminders for medication adherence and scheduled exercise (even light walking 3-4 times weekly). Track your weight weekly to monitor for fluid retention, which is important in dialysis patients.
- Create a dashboard showing your fasting glucose trend over weeks and months. Set alerts if readings consistently exceed your target range. Share monthly reports with your nephrologist. Also monitor and log any cardiovascular symptoms, blood pressure readings, and medication changes to identify patterns that correlate with blood sugar control.
This article summarizes research findings and should not be considered medical advice. If you have pre-diabetes, diabetes, or kidney disease, consult with your healthcare provider before making any changes to your diet, exercise routine, or medications. The findings in this study apply specifically to peritoneal dialysis patients and may not apply to other populations or types of kidney treatment. Individual risk factors vary, and personalized medical guidance from your doctor is essential for managing your health.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.