Influence of erythropoiesis-stimulating agents on glycated hemoglobin in nondiabetic kidney diseases at the start of dialysis.
BACKGROUND
Although glycated hemoglobin (HbA₁(C)) is a practical tool to assess long-term glucose control in the general population, it may underestimate glycemic control in chronic kidney disease (CKD) patients - especially those undergoing treatment with erythropoiesis-stimulating agents (ESA). We evaluated the association of HbA₁(C) with other parameters of glucose homeostasis and tested its association with ESA use and mortality in nondiabetic incident dialysis patients.


METHODS
We studied 270 nondiabetic CKD stage 5 patients referred to initiate dialysis therapy [median age: 54 years (43-63), 154 males]. Patients were followed for up to 5 years for survival analysis.


RESULTS
HbA₁(C) was positively correlated with age (Rho = 0.13; p = 0.031), C-reactive protein (Rho = 0.14; p = 0.024), total cholesterol (Rho = 0.19; p = 0.001), triglycerides (Rho = 0.21; p < 0.001) and glucose (Rho = 0.21; p = 0.001), but it was negatively correlated with HDL-cholesterol (Rho = -0.22; p < 0.001) and ESA dose (Rho = -0.27; p < 0.001). Across increasing HbA₁(C) tertiles, increased glucose levels and reduced use of ESA and dose of ESA were observed (p < 0.001), but there were no differences in insulin and HOMA index. In a stepwise multivariate linear regression analysis, ESA dose was negatively associated with logHbA₁(C). HbA₁(C) did not predict mortality.


CONCLUSIONS
In nondiabetic CKD stage 5 patients, HbA₁(C) levels were associated with ESA dose. HbA₁(C) was not independently associated with surrogate markers of insulin resistance or mortality.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Antonio Carlos
AC
Cordeiro
Juan Jesús
JJ
Carrero
Peter
P
Bárány
Abdul Rashid
AR
Qureshi
Olof
O
Heimbürger
Bengt
B
Lindholm
Peter
P
Stenvinkel
D000328:Adult; D008076:Cholesterol, HDL / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005947:Glucose / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006397:Hematinics / Q000627:therapeutic use*; D006706:Homeostasis; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000097:blood*
D008076:Cholesterol, HDL; D005947:Glucose; D006442:Glycated Hemoglobin; D006397:Hematinics