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Perit Dial Int 30(1): 72-79
2010
© 2010 International Society for Peritoneal Dialysis
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Clinical

COMPARISON OF GLYCATED ALBUMIN AND HEMOGLOBIN A1c CONCENTRATIONS IN DIABETIC SUBJECTS ON PERITONEAL AND HEMODIALYSIS

Barry I. Freedman1, Rajeev N. Shenoy1, Jonathan A. Planer1, Kimberly D. Clay1, Zak K. Shihabi2, John M. Burkart1, Cesar Y. Cardona1, Lilian Andries1, Todd P. Peacock1, Hernan Sabio3, Joyce R. Byers1, Gregory B. Russell4 and Anthony J. Bleyer1

Departments of Internal Medicine,1 Pathology,2 Pediatrics,3 and Biostatistical Sciences,4 Wake Forest University School of Medicine, Winston–Salem, North Carolina, USA

Correspondence to: B.I. Freedman, Section on Nephrology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston–Salem, North Carolina 27157-1053 USA. bfreedma{at}wfubmc.edu

{diamondsuit} Background: Relative to hemoglobin A1c (HbA1c), percentage of glycated albumin (GA%) more accurately reflects recent glycemic control in diabetic hemodialysis (HD) patients.

{diamondsuit} Methods: To determine the accuracy of glycemic assays in a larger sample including patients on peritoneal dialysis (PD), HbA1c and GA% were measured in 519 diabetic subjects: 55 on PD, 415 on HD, and 49 non-nephropathy controls.

{diamondsuit} Results: Mean ± SD serum glucose levels were higher in HD and PD patients relative to non-nephropathy controls (HD 169.7 ± 62 mg/dL, PD 168.6 ± 66 mg/dL, controls 146.1 ± 66 mg/dL; p = 0.03 HD vs controls, p = 0.13 PD vs controls). GA% was also higher in HD and PD patients (HD 20.6% ± 8.0%, PD 19.0% ± 5.7%, controls 15.7% ± 7.7%; p < 0.02 HD vs controls and PD vs controls). HbA1c was paradoxically lower in dialysis patients (HD 6.78% ± 1.6%, PD 6.87% ± 1.4%, controls 7.3% ± 1.4%; p = 0.03 HD vs controls, p = 0.12 PD vs controls). The serum glucose/HbA1c ratio differed significantly between dialysis patients and controls (p < 0.0001 HD vs controls, p = 0.002 PD vs controls), while serum glucose/GA% ratio was similar across groups (p = 0.96 HD vs controls, p = 0.64 PD vs controls). In best-fit multivariate models with HbA1c or GA% as outcome variable, dialysis status was a significant predictor of HbA1c but not GA%.

{diamondsuit} Conclusions: The relationship between HbA1c and GA% differs in diabetic patients with end-stage renal disease who perform either PD or HD compared to those without nephropathy. HbA1c significantly underestimates glycemic control in peritoneal and hemodialysis patients relative to GA%.

KEY WORDS: Diabetes mellitus; end-stage renal disease; glycated albumin; glycemic control; hemoglobin A1c.

Received 21 October 2008; accepted 3 March 2009.






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