title: Impact of elevated serum glycated albumin levels on contrast-induced acute kidney injury in diabetic patients with moderate to severe renal insufficiency undergoing coronary angiography.
abstract: BACKGROUND
  Glycated albumin (GA) has been shown to be a better indicator than glycosylated hemoglobin A1c (HbA1c) in terms of severity of renal impairment in patients with type 2 diabetes mellitus (T2DM). This study aimed to determine whether elevated serum GA levels are associated with an increased risk for contrast-induced acute kidney injury (CI-AKI) and worse clinical outcome in patients with T2DM and at least moderate renal insufficiency (RI) undergoing coronary angiography.
  
  
  METHODS
  Serum levels of fasting blood glucose (FBG), HbA1c and GA were measured in 1030 patients with T2DM and moderate to severe RI (eGFR 15-59 mL/min/1.73 m(2)). CI-AKI was defined as ≥ 25% increase in serum creatinine within 72 h after the procedure. Receiver-operating characteristic curve was constructed to assess the predictive value of GA, HbA1c and FBG for CI-AKI. Multivariable logistic regression model was developed to identify risk factors for CI-AKI, and Kaplan-Meier curve analysis was used to compare the rates of dialysis and major adverse cardiac events (MACE) during one-year follow-up.
  
  
  RESULTS
  The overall rate of CI-AKI was 11.1%. GA was significantly higher in patients with CI-AKI than in those without, and correlated positively with changes of renal function after the procedure. After adjusting for age, sex, left ventricular ejection fraction, multi-vessel disease, type and volume of contrast media, FBG, and HbA1c, GA remained an independent risk factor for CI-AKI. GA ≥ 21% was associated with increased rates of dialysis and MACE during one-year follow-up in patients with or without CI-AKI.
  
  
  CONCLUSIONS
  Increased GA level serves as a valuable risk factor for CI-AKI and indicates poor one-year clinical outcome in patients with T2DM and moderate to severe RI.
authors.affiliation: Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China.
authors.forename: Feng Hua
authors.initials: FH
authors.lastname: Ding
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Rui Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Tian Qi
authors.initials: TQ
authors.lastname: Zhu
authors.forename: Li Jin
authors.initials: LJ
authors.lastname: Pu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Qiu Jing
authors.initials: QJ
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Zhen Kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D017127:Glycation End Products, Advanced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin