Glycated albumin is a more accurate glycaemic indicator than haemoglobin A 1c in diabetic patients with pre‐dialysis chronic kidney disease

Aim Glycated albumin ( GA ) has been reported to be a more reliable glycaemic indicator than haemoglobin A 1c ( HbA 1c ) in patients with diabetes on dialysis. However, the significance of these assays has been less evaluated in patients with diabetes and pre‐dialysis chronic kidney disease ( CKD ). Methods GA , HbA 1c and fasting serum glucose were measured simultaneously in 146 patients with diabetes. Based on estimated glomerular filtration rate ( eGFR ), the subjects were categorized into a pre‐dialysis CKD group ( eGFR  < 60 mL/min per 1.73 m 2 , n  = 97) and a non‐ CKD group ( eGFR  ≥ 60 mL/min per 1.73 m 2 , n  = 49). Results The glucose/ HbA 1c and GA / HbA 1c ratios were significantly higher in the CKD group than those in the non‐ CKD group. The glucose/ GA ratio did not differ significantly between the two groups. In the pre‐dialysis CKD group, eGFR was negatively correlated with the glucose/ HbA 1c ratio ( r  = −0.343, P  = 0.001) and the GA / HbA 1c ratio ( r  = −0.499, P  < 0.001). However, no significant correlation was detected between eGFR and the glucose/ GA ratio. In the non‐ CKD group, eGFR was not correlated with the glucose/ HbA 1c ratio, the glucose/ GA ratio, or the GA / HbA 1c ratio. A multivariate regression analysis showed that eGFR had a significant impact on HbA 1c but no effect on GA in the pre‐dialysis CKD group (β = 0.210, P  = 0.005). In the non‐ CKD group, eGFR did not affect HbA 1c or GA . Conclusion Our results show that HbA 1c significantly underestimated glycaemic control, whereas GA more accurately reflected glycaemic control in diabetic patients with pre‐dialysis CKD .