title: Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection.
abstract: The significance of glycated albumin (GA), compared with casual plasma glucose (PG) and glycated hemoglobin (HbA(1c)), was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. The mean PG, GA, and HbA(1c) levels were 164.5 +/- 55.7 mg/dl, 22.5 +/- 7.5%, and 5.85 +/- 1.26%, respectively, in HD patients with diabetes (n = 538), which were increased by 51.5, 31.6, and 17.7%, respectively, compared with HD patients without diabetes (n = 828). HbA(1c) levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the relationship among the three parameters in patients who had diabetes without renal dysfunction (n = 365), as reflected by the significantly more shallow slope of regression line between HbA(1c) and PG or GA. A significant negative correlation was found between GA and serum albumin (r = -0.131, P = 0.002) in HD patients with diabetes, whereas HbA(1c) correlated positively and negatively with hemoglobin (r = 0.090, P = 0.036) and weekly dose of erythropoietin injection (r = -0.159, P < 0.001), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA(1c) levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartile by HbA(1c) level led to better glycemic control in a significantly higher proportions of HD patients with diabetes than those assessed by GA. Multiple regression analysis demonstrated that the weekly dose of erythropoietin, in addition to PG, emerged as an independent factor associated with HbA(1c) in HD patients with diabetes, although PG but not albumin was an independent factor associated with GA. In summary, it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA(1c) in these patients might lead to underestimation likely as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. inaba-m@med.osaka-cu.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Senji
authors.initials: S
authors.lastname: Okuno
authors.forename: Yasuro
authors.initials: Y
authors.lastname: Kumeda
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yamada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Imanishi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tabata
authors.forename: Mikio
authors.initials: M
authors.lastname: Okamura
authors.forename: Shigeki
authors.initials: S
authors.lastname: Okada
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood / Q000628:therapy; D004921:Erythropoietin / Q000494:pharmacology / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000187:drug effects; D017127:Glycation End Products, Advanced; D006031:Glycosylation; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects; D012709:Serum Albumin / Q000032:analysis* / Q000187:drug effects; D000093423:Glycated Serum Albumin
chemical_list: D001786:Blood Glucose; D004921:Erythropoietin; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin