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Target for Glycemic Control in Type 2 Diabetic Patients on Hemodialysis: Effects of Anemia and Erythropoietin Injection on Hemoglobin A 1c
Author(s) -
Uzu Takashi,
Hatta Tsuguru,
Deji Naoko,
Izumiya Tamani,
Ueda Hisami,
Miyazawa Itsuko,
Kanasaki Masami,
Isshiki Keiji,
Nishio Toshiji,
Arimura Tetsuro
Publication year - 2009
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2009.00661.x
Subject(s) - medicine , glycemic , hemoglobin , erythropoietin , hematocrit , hemodialysis , anemia , endocrinology , glycated hemoglobin , diabetes mellitus , albumin , gastroenterology , type 2 diabetes
In hemodialysis (HD) patients the glycated hemoglobin (Hb A1c ) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients ( N = 87) who had been receiving maintenance HD for at least one year were enrolled. Hb A1c and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/Hb A1c ratio were examined. There were significant and positive correlations between the plasma glucose and either the Hb A1c levels (r = 0.539, P < 0.01) or the %GA level (r = 0.520, P < 0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlated with the ratio of %GA/Hb A1c and hematocrit (Ht) correlated negatively. There was no significant correlation between the %GA/Hb A1c level and the EPO dose in patients with Ht ≥ 30%, although a significant correlation was found between those parameters in the Ht < 30% group. The mean of the %GA/Hb A1c ratios in patients with Ht ≥ 30%, with Ht < 30% and treated with EPO < 100 IU/kg/week, and with Ht < 30% and treated with EPO ≥ 100 IU/kg/week were 3.41, 3.56 and 4.13, respectively. In HD patients, accurate glycemic control may be estimated as: Hb A1c × 1.14 if Ht ≥ 30%; Hb A1c × 1.19 if Ht < 30% and treated with low dosages of EPO; and Hb A1c × 1.38 if Ht < 30% and treated with high dosages of EPO.