Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A(1c).
In hemodialysis (HD) patients the glycated hemoglobin (Hb(A1c)) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients (N = 87) who had been receiving maintenance HD for at least one year were enrolled. Hb(A1c) and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/Hb(A1c) ratio were examined. There were significant and positive correlations between the plasma glucose and either the Hb(A1c) levels (r = 0.539, P < 0.01) or the %GA level (r = 0.520, P < 0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlated with the ratio of %GA/Hb(A1c) and hematocrit (Ht) correlated negatively. There was no significant correlation between the %GA/Hb(A1c) level and the EPO dose in patients with Ht > or = 30%, although a significant correlation was found between those parameters in the Ht < 30% group. The mean of the %GA/Hb(A1c) ratios in patients with Ht > or = 30%, with Ht < 30% and treated with EPO < 100 IU/kg/week, and with Ht < 30% and treated with EPO > or = 100 IU/kg/week were 3.41, 3.56 and 4.13, respectively. In HD patients, accurate glycemic control may be estimated as: Hb(A1c) x 1.14 if Ht > or = 30%; Hb(A1c) x 1.19 if Ht < 30% and treated with low dosages of EPO; and Hb(A1c) x 1.38 if Ht < 30% and treated with high dosages of EPO.
Uzu
Takashi
T
Department of Medicine, Shiga University of Medical Science, Shiga, Japan. takuzu@belle.shiga-med.ac.jp
Hatta
Tsuguru
T
Deji
Naoko
N
Izumiya
Tamani
T
Ueda
Hisami
H
Miyazawa
Itsuko
I
Kanasaki
Masami
M
Isshiki
Keiji
K
Nishio
Toshiji
T
Arimura
Tetsuro
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006400:Hematocrit; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism
D001786:Blood Glucose; D004921:Erythropoietin; D006442:Glycated Hemoglobin; D011994:Recombinant Proteins; D012709:Serum Albumin