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Measurement of Hba(1C) in patients with chronic renal failure

Randie R Little1, Curt L Rohlfing, Alethea L Tennill

  • 1Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, One Hospital Dr., Columbia, MO 65212, USA. littler@health.missouri.edu

Clinica Chimica Acta; International Journal of Clinical Chemistry
|January 16, 2013
PubMed

Insights

Diabetic patients with chronic renal failure (CRF) may have inaccurate HbA1c results. While most methods are accurate, healthcare providers should interpret HbA1c cautiously due to shortened erythrocyte survival in CRF.

Area of Science:

  • Clinical Chemistry
  • Nephrology
  • Endocrinology

Background:

  • Carbamylated hemoglobin (carbHb) may interfere with HbA1c measurements.
  • Shortened erythrocyte survival in chronic renal failure (CRF) can lead to low HbA1c results.

Purpose of the Study:

  • Evaluate carbHb's effect on HbA1c measurements.
  • Compare HbA1c with glycated albumin (GA) in patients with and without renal disease.
  • Determine if CRF causes clinically significant bias in HbA1c results.

Main Methods:

  • Assessed 11 assay methods for HbA1c measurement.
  • Included patients with and without renal failure and diabetes.
  • Used estimated glomerular filtration rate (eGFR) to assess renal disease severity.
  • Employed multiple regression analysis to evaluate eGFR's impact on HbA1c.
  • Compared HbA1c and GA in renal failure patients.

Main Results:

  • Some methods showed statistically significant eGFR effects, but none were clinically significant.
  • HbA1c results were approximately 1.5% lower in renal failure patients compared to GA, assuming GA reflects glycemic control better.

Conclusions:

  • Most methods accurately measure HbA1c in renal failure patients.
  • Healthcare providers must interpret HbA1c results cautiously in CRF patients.
  • Shortened erythrocyte survival is a key factor influencing HbA1c interpretation in renal failure.
Abstract

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