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Relationship between assays of glycemia in diabetic subjects with advanced chronic kidney disease

Barry I Freedman1, Zak K Shihabi, Lilian Andries

  • 1Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA. bfreedma @ wfubmc.edu

American Journal of Nephrology
|March 20, 2010
PubMed

Insights

Glycated albumin (GA) and hemoglobin A1c (HbA1c) reflect glycemic control differently in advanced chronic kidney disease (CKD). Reduced glomerular filtration rate (GFR) impacts HbA1c accuracy more than GA in diabetic CKD patients.

Area of Science:

  • Nephrology
  • Diabetology
  • Clinical Chemistry

Background:

  • Hemoglobin A1c (HbA1c) is a standard measure of long-term glycemic control.
  • Glycated albumin (GA) offers a shorter-term glycemic control assessment, potentially more accurate in dialysis patients.
  • Limited comparative data exists for GA and HbA1c in advanced chronic kidney disease (CKD).

Purpose of the Study:

  • To compare the accuracy of glycated albumin (GA) and hemoglobin A1c (HbA1c) in assessing glycemic control in diabetic patients with varying stages of chronic kidney disease (CKD).

Main Methods:

  • Simultaneous measurement of HbA1c and GA in 303 diabetic subjects.
  • Study groups included pre-dialysis CKD stage 4, post-transplant CKD stage 3, and non-nephropathy controls.
  • Glomerular filtration rate (GFR) was estimated for all participants.

Main Results:

  • The GA:HbA1c ratio significantly differed between non-nephropathy controls and CKD patients (p < 0.001).
  • The glucose:HbA1c ratio showed an inverse association with GFR in nephropathy cases (r = -0.13; p = 0.04).
  • Glucose:GA ratio did not significantly vary with GFR (r = -0.08; p = 0.24).

Conclusions:

  • Reduced GFR in diabetic CKD patients influences the relationship between GA and HbA1c.
  • The accuracy of HbA1c in severe nephropathy warrants further investigation.
  • HbA1c demonstrates relatively good performance in milder stages of CKD.
Abstract

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