Glycated Albumin and Cardiovascular Mortality in CKD Stage V Patients with Diabetes Mellitus: A Five-Year Follow-Up
Ana Bulatovic1,2, Nada Dimkovic3, Svetlana Jelic2
1Clinical Department for Nephrology, University Medical Center Zvezdara, 11000 Belgrade, Serbia.
Insights
Glycated albumin (GA) is a more accurate marker for assessing glycemic control in hemodialysis patients with diabetes than hemoglobin A1c (HbA1c). GA also shows a trend towards predicting cardiovascular mortality in this population.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Glycemic assessment in chronic kidney disease (CKD) Stage V patients on hemodialysis (HD) is challenging due to hemoglobin A1c (HbA1c) inaccuracies.
- Anemia, reduced erythrocyte lifespan, and erythropoiesis-stimulating agent (ESA) therapy affect HbA1c reliability in CKD patients.
- Glycated albumin (GA), unaffected by erythrocyte turnover, may offer a more accurate reflection of glycemic exposure.
Purpose of the Study:
- To evaluate the diagnostic performance and clinical utility of GA as a biomarker for poor glycemic control.
- To assess GA's role in predicting cardiovascular risk in patients with diabetes mellitus (DM) undergoing hemodialysis.
- To compare GA with HbA1c and mean plasma glucose (PG3m) in this patient cohort.
Main Methods:
- Cross-sectional analysis and a five-year prospective follow-up were conducted.
- Three subgroups were analyzed: HD+DM+ (n=40), HD- DM+ (n=15), and HD+DM- (n=22).
- Glycemic markers including PG3m, GA, and HbA1c were measured and compared.
Main Results:
- GA levels were significantly higher in HD+DM+ patients and correlated strongly with PG3m.
- GA independently predicted poor glycemic control (OR 3.23) with high diagnostic accuracy (AUC 0.873, cut-off 10%).
- GA showed a trend toward predicting higher cardiovascular mortality risk (HR 2.56), while HbA1c was not prognostic (HR 1.39).
Conclusions:
- GA is a clinically useful marker for glycemic control in diabetic patients with CKD Stage V on maintenance hemodialysis.
- GA demonstrates superior diagnostic accuracy and a better sensitivity/specificity profile than HbA1c in this population.
- Further large-scale prospective studies are recommended to validate GA's prognostic value for cardiovascular mortality.
Abstract:
Glycemic assessment in patients with chronic kidney disease (CKD) Stage V on hemodialysis (HD) is limited by the inaccuracy of hemoglobin A1c (HbA1c), mainly due to anemia, shortened erythrocyte lifespan, and erythropoiesis-stimulating agent (ESA) therapy. Glycated albumin (GA), independent of erythrocyte turnover, may better reflect glycemic exposure. We evaluated the diagnostic performance and clinical utility of GA as a biomarker of poor glycemic control and cardiovascular risk in patients with diabetes mellitus (DM). A cross-sectional analysis and five-year prospective follow-up were conducted in three subgroups: HD+DM+ (n = 40), HD- DM+ (n = 15), and HD+DM- (n = 22). Glycemic markers (mean plasma glucose over 3 months (PG3m), GA, and HbA1c) were compared between groups. GA levels were significantly higher in HD+DM+ patients (p < 0.001) and showed the strongest correlation with PG3m. GA independently predicted poor glycemic control (OR 3.23; 95% CI 1.54-6.77; p = 0.002) and demonstrated high diagnostic accuracy (AUC 0.873; optimal cut-off 10%). During the five-year follow-up, CV mortality was 35%, and 85% of deceased patients had GA > 10%. Although Cox regression did not reach statistical significance, GA showed a consistent trend toward higher CV mortality risk after adjustment for age and HD duration (HR 2.56; 95% CI 0.57-11.44; p = 0.21), whereas HbA1c was not prognostic (HR 1.39; 95% CI 0.49-3.91; p = 0.28). GA appears to be a clinically useful marker of glycemic control in diabetic patients with CKD Stage V receiving maintenance hemodialysis. In this cohort, GA showed high diagnostic accuracy and a more balanced sensitivity/specificity profile compared with HbA1c, with a consistent trend toward association with cardiovascular mortality. In this regard, the wider use of this marker in clinical practice is worth considering. Nevertheless, larger prospective studies are warranted to validate these observations.
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