Specific affinity-chromatographic measurement of glycated hemoglobins in uremic patients

The clinical utility of glycated hemoglobin measurements in renal failure is controversial, given numerous earlier studies showing no correlation between glycated hemoglobin and other indicators of blood glucose control in uremic subjects. This problem is attributable, in part, to analytical interferences from carbamylated hemoglobins. We report use of a specific affinity method to measure glycated hemoglobins in a group of uremic patients, diabetic and nondiabetic, undergoing treatment by continuous ambulatory peritoneal dialysis. Concentrations of glycated hemoglobins correlated significantly with values for fasting plasma glucose (r = 0.52, n = 17, p less than 0.05) in these patients and with mean glucose measurements in five diabetic patients who used home glucose monitoring (r = 0.91, p less than 0.05). Contrary to studies with ion-exchange chromatography, our measurements of glycated hemoglobin showed no positive correlation with concentrations of urea in serum. In a separate group of patients, we found that hemodialysis sessions produced no acute effect on glycated hemoglobin. Measurements of glycated hemoglobins by analytically specific methods may thus better reflect long-term control of blood glucose in renal dialysis.