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Glycated albumin is a more accurate glycaemic indicator than haemoglobin A 1c in diabetic patients with pre‐dialysis chronic kidney disease
Author(s) -
Kim Il Young,
Kim Min Jung,
Lee Dong Won,
Lee Soo Bong,
Rhee Harin,
Song Sang Heon,
Seong Eun Young,
Kwak Ihm Soo
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12508
Subject(s) - medicine , albumin , glycated haemoglobin , kidney disease , dialysis , disease , diabetes mellitus , urology , gastroenterology , intensive care medicine , endocrinology , type 2 diabetes
Abstract 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 .