title: Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis.
abstract: OBJECTIVE
  Glycated albumin (GA) is recognized as a reliable marker for monitoring glycemic control particularly in patients with end-stage renal disease (ESRD). Here, we investigated the impact of GA levels on long-term survival in diabetic patients with ESRD.
  
  
  METHODS
  We enrolled ESRD patients with diabetic nephropathy into our single-centre prospective follow-up study (n = 98, 66 men and 32 women; age 68.2 12.3 years) with a mean follow-up period of 47.7 months. All patients had started haemodialysis between December 1992 and November 2003. They were categorized into two groups according to their GA levels at the initiation of haemodialysis; GA < 29% (low-GA group; n = 54) and GA 29% (high-GA group; n = 44).
  
  
  RESULTS
  Between low-GA and high-GA groups, there were no significant differences in various clinical parameters except GA and HbA1c levels. The cumulative survival rate of low-GA group was significantly higher than that of high-GA group (P = 0.034, log-rank test). After adjustment for age, sex, total cholesterol, C-reactive protein and albumin, high-GA was a significant predictor of survival (hazard ratio 1.042 per 1.0% increment of GA, 95% CI 1.014-1.070, P < 0.05), but not in the case with HbA1c. Cox proportional hazard model demonstrated that high-GA group was a significant predictor for cardiovascular death (hazard ratio 2.971 (1.064-8.298), P = 0.038).
  
  
  CONCLUSIONS
  We conclude that poor glycemic control (GA 29%) before starting haemodialysis is associated with increased cardiovascular morbidity and shortened survival in diabetic patients with ESRD.
authors.affiliation: Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Shigei Medical Research Hospital, Okayama, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Fukuoka
authors.forename: Kazushi
authors.initials: K
authors.lastname: Nakao
authors.forename: Hisanori
authors.initials: H
authors.lastname: Morimoto
authors.forename: Ai
authors.initials: A
authors.lastname: Nakao
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takatori
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Arimoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taki
authors.forename: Jun
authors.initials: J
authors.lastname: Wada
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D017127:Glycation End Products, Advanced; D006436:Hemodialysis Units, Hospital; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human