[Hemoglobin A1c in patients under periodic hemodialysis or continuous ambulatory peritoneal dialysis]

In 44 dialyzed patients (27 nondiabetic hemodialysis, 10 CAPD patients and 7 diabetics) hemoglobin A1c (HbA1c) concentrations were measured comparatively by column chromatography (using Bio-Rad columns) and the thiobarbituric acid (TBA) method. With column chromatography the values were significantly higher in each patient group than in healthy controls. In the diabetics, who on average showed elevated blood glucose levels, HbA1c concentrations were higher than in the other dialysis patients, although there was some overlap. On the other hand, concentrations measured in non-diabetic patients with the TBA method were only marginally higher than in controls. It is well known that column chromatography measures carbamylated hemoglobin with HbA1c, and for this reason false high concentrations are found in renal failure. The TBA method is precise and specific in this situation but unfortunately is too time-consuming for routine determinations. The simple column chromatographic method is of only limited value in the control of diabetics with renal failure; nevertheless, unequivocally elevated concentrations of greater than or equal to 7% HbA1c are a good indicator of unsatisfactory metabolic control.