title: Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A(1c).
abstract: 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.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Shiga, Japan. takuzu@belle.shiga-med.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Uzu
authors.forename: Tsuguru
authors.initials: T
authors.lastname: Hatta
authors.forename: Naoko
authors.initials: N
authors.lastname: Deji
authors.forename: Tamani
authors.initials: T
authors.lastname: Izumiya
authors.forename: Hisami
authors.initials: H
authors.lastname: Ueda
authors.forename: Itsuko
authors.initials: I
authors.lastname: Miyazawa
authors.forename: Masami
authors.initials: M
authors.lastname: Kanasaki
authors.forename: Keiji
authors.initials: K
authors.lastname: Isshiki
authors.forename: Toshiji
authors.initials: T
authors.lastname: Nishio
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Arimura
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D004921:Erythropoietin; D006442:Glycated Hemoglobin; D011994:Recombinant Proteins; D012709:Serum Albumin