Related Experiment Video
Updated: Jun 11, 2026
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Comparative Analysis of HbA1c Estimation Using Immunoturbidimetry and High-Pressure Liquid Chromatography Methods in
Chanchal Dhingra1, Namrata Rao1, Shefali Singh1
1Department of Biochemistry, Dr Ram Manohar Institute of Medical Sciences, Lucknow, Uttar Pradesh.
Insights
High-pressure liquid chromatography (HPLC) accurately measures HbA1c in chronic kidney disease (CKD) patients, unlike turbidimetric inhibition immunoassay (TINIA), which fails in anemic individuals. HPLC is recommended for reliable diabetes mellitus monitoring in CKD.
Area of Science:
- Clinical Chemistry
- Nephrology
- Endocrinology
Background:
- Chronic kidney disease (CKD) poses challenges in monitoring glycemic control, particularly in patients with diabetes mellitus (DM).
- Anemia and uremia in CKD patients complicate accurate measurement of Hemoglobin A1c (HbA1c).
Purpose of the Study:
- To compare the performance of turbidimetric inhibition immunoassay (TINIA) and high-pressure liquid chromatography (HPLC) for HbA1c measurement in non-dialysis CKD patients.
- To identify factors affecting HbA1c measurement accuracy in this population.
Main Methods:
- An analytical cross-sectional study was conducted with 127 non-dialysis CKD patients.
- HbA1c levels were measured using both TINIA and HPLC methods.
- Correlation and agreement between the two methods were analyzed, along with the influence of anemia and carbamylated hemoglobin (CHb).
Main Results:
- TINIA failed to detect HbA1c in 27% of anemic patients, while HPLC provided measurable results for all.
- A strong positive correlation (R2=0.861) and substantial agreement (Cohen's kappa 0.657) were observed between TINIA and HPLC in the 100 patients where both methods yielded results.
- HPLC reported significantly higher HbA1c levels in diabetic CKD patients compared to TINIA. Carbamylated hemoglobin (CHb) correlated with both HbA1c measurements and serum urea levels.
Conclusions:
- HPLC is superior to TINIA for HbA1c measurement in CKD patients, especially those with anemia, as it provides complete assessment.
- TINIA underestimates HbA1c in diabetic CKD patients due to interference from factors like low hemoglobin and high carbamylated hemoglobin.
- Accurate HbA1c monitoring in CKD requires methods robust to anemia and other biochemical alterations.
Background:
Chronic kidney disease (CKD) concomitant with diabetes mellitus (DM), anemia and uremia. Thus, monitoring HbA1c levels presents a complex clinical challenge.
Methods:
This analytical cross-sectional study was conducted from May 2022 to April 2023 at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. We compared HbA1c values obtained by the turbidimetric inhibition immunoassay (TINIA) and high-pressure liquid chromatography (HPLC) methods among non-dialysis CKD patients (n=127).
Results:
HbA1c was not detectable among 27 patients by TINIA but measurable with HPLC, all being's anemic. The remaining 100 patients, it was detectable by both the methods. Among these 100 patients, linear regression analysis showed a very strong positive correlation between TINIA-HbA1c and HPLC-HbA1c (R2=0.861; p<0.0001). The agreement between methods was substantial (Cohen's kappa 0.657; p<0.0001). However, HbA1c levels were detected significantly higher with HPLC (Median 7.9, IQR 2.7) than that of TINIA (Median 7.0, IQR 2.9;p=0.025) in diabetics while the difference was not significant in non-diabetic group with both HPLC (Median 5.4,IQR 0.8) and TINIA (Median 5.1,IQR 1.1). Carbamylated Hb (CHb; as detected by HPLC as a side product) was correlated to both HbA1c by HPLC (r=0.299;p=0.007) and TINIA (r=0.336;p=0.006) as well as to serum urea levels (r=0.439;p<0.0001).
Conclusion:
HPLC estimates all HbA1c patients in our study group while TINIA failed to do so in around 21.26% cases. The very low hemoglobin levels and high carbamylated hemoglobin were apparent as two most common causes. Also, the values with TINIA are significantly lower in comparison to HPLC among diabetics with CKD.
More Related Videos
Related Concept Videos
01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
Renal clearance is often associated with the renal glomerular filtration rate (GFR), which represents the rate at which plasma is filtered through the glomeruli in the kidney. When drug reabsorption is minimal and there is no active secretion, renal clearance is closely related to the...
01:25Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration