Association between liver and chronic kidney disease on hemoglobin A1c concentrations
George W Pratt1, Caixia Bi2, Martin H Kroll2
1Quest Diagnostics, North Region, Marlborough, MA, USA.
Summary
Liver disease (LD) and chronic kidney disease (CKD) can elevate Hemoglobin A1c (HbA1c) test results. Healthcare providers should consider these conditions when monitoring diabetes management using HbA1c levels.
Area of Science:
- Clinical chemistry
- Endocrinology
- Nephrology
Background:
- Hemoglobin A1c (HbA1c) is a key indicator for long-term glycemic control in type-2 diabetes mellitus.
- Liver disease (LD) and chronic kidney disease (CKD) can potentially lead to inaccurate HbA1c readings.
- Existing literature presents conflicting information regarding the interplay between HbA1c, LD, and CKD.
Purpose of the Study:
- To investigate the impact of liver disease (LD) and chronic kidney disease (CKD) on Hemoglobin A1c (HbA1c) measurements.
- To clarify the relationship between HbA1c levels and the presence of LD or CKD in patients.
- To inform clinical practice regarding the interpretation of HbA1c results in the context of specific comorbidities.
Main Methods:
- Retrieved HbA1c concentration data from 2015-2019.
- Analyzed over 2,500 results from patients with LD and 20,000 from patients with CKD.
- Classified LD based on elevated ALT and AST; CKD based on serum creatinine, BUN, or low eGFR.
- Employed Kruskal-Wallis statistical analysis to compare population distributions and significance.
Main Results:
- Median HbA1c was significantly higher in patients with LD (5.8%) compared to those without (5.4% female, 5.6% male).
- Median HbA1c was significantly elevated in patients with CKD (5.7% female, 6.0% male) versus non-CKD samples (5.4% female, 5.6% male).
- HbA1c concentrations showed a trend of increasing with CKD stage from 1 to 4, then decreasing at stage 5.
Conclusions:
- Elevated HbA1c concentrations can be observed in patients with liver disease (indicated by high AST/ALT) or chronic kidney disease.
- Clinicians must consider the patient's LD and CKD status when interpreting HbA1c levels for diabetes monitoring.
- Accounting for LD and CKD is crucial for making informed therapeutic decisions in diabetes management.
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