Correlation between glycated hemoglobin and mean plasma glucose in hemodialysis patients.
BACKGROUND
Since the half-life of red blood cells (RBCs) is shorter in hemodialysis patients, the value of glycated hemoglobin (HbA1c) as a marker of glycemic control in patients with diabetes on hemodialysis has recently been questioned. It is thought that it is not a good marker of mean plasma glucose (MPG) over a 3-month duration. In our current study, we evaluate whether monthly HbA1c values is a better marker of glycemic control than HbA1c every 3 months.


METHODS
We performed a cross-sectional analysis of a retrospective cohort of 152 patients with diabetes who presented to two hemodialysis units in NYC. Patients had weekly predialysis glucose levels checked over the last 3 months, and HbA1c values were checked every 3 months. Data collection spanned a 6-month time frame from August 2008 to January 2009.


RESULTS
We found no difference in the correlation between HBA1c/mean plasma glucose (MPG) over the last month (MPG1m) and HbA1c/mean plasma glucose (MPG) over the last 3 months (MPG3m; r = 0.57 and r = 0.53, respectively; P = 0.212). Using multivariate analysis, reticulocyte count and weekly erythropoietin dose were found to independently and inversely effect the correlations HbA1c/MPG1m and HbA1c/MPG3m.


CONCLUSIONS
The value of HbA1c in hemodialysis for monitoring glycemic control is limited in the setting of a high reticulocyte count (>2%) and a high weekly erythropoietin dose. Checking HbA1c monthly versus every 3 months is not a better approximation of glycemic control in hemodialysis patients.
Israel
Ezra
E
Department of Internal Medicine, Nephrology Division, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA.
Geara
Abdallah
A
Maarouf
Omar
O
Ayoub
Isabelle
I
Abi Rached
Jacques
J
Rizk
Sanaa
S
Staynberg
Norbert
N
Samarneh
Majed
M
El-Sayegh
Suzanne
S
D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood* / Q000150:complications / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D006435:Renal Dialysis; D017701:Reticulocyte Count; D012189:Retrospective Studies
D001786:Blood Glucose; D004921:Erythropoietin; D006442:Glycated Hemoglobin