Association between liver and chronic kidney disease on hemoglobin A1c concentrations

HbA1c is the gold standard for measuring long-range glycemic control in patients with type-2 diabetes mellitus. Conditions such as CKD or LD can lead to spurious HbA1c test results. There is conflicting literature about the relationship between HbA1c, LD, and CKD.

Results for HbA1c concentrations were retrieved from 2015- to 2019. We evaluated over 2,500 test results with LD and 20,000 results with CKD compared to over 21,000 test results without LD, iron deficiency anemia, or CKD. Patients were classified as having LD if they had high ALT and AST concentrations and classified as CKD, if they have abnormal serum creatinine and BUN or low eGFR based on age-based reference ranges. Kruskal-Wallis statistical analyses method was used to test whether the two populations followed the same distribution and significance.

The median HbA1c concentration was 5.8% (40 mmol/l) among LD classified patients in both males and females vs. 5.4% (36 mmol/l) (P < 0.001) for females and 5.6% (38 mmol/l) (P < 0.001) for males without LD. A significant difference in median HbA1c concentrations were also observed between CKD samples (female: 5.7% (39 mmol/l), male: 6.0% (42 mmol/l)) and non-CKD samples (female: 5.4% (36 mmol/l), male: 5.6% (38 mmol/l)) (P < 0.001). Depending on the population's CKD stage, median concentrations of % HbA1c are increased from stage-1 through stage-4 and fell in Stage-5.

Patients with high AST and ALT concentrations or CKD can have increased HbA1c concentrations compared to normal patients. When using HbA1c concentrations to monitor diabetes, healthcare professionals should consider LD or CKD status before making any therapeutic decisions.