title: Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis.
abstract: BACKGROUND
  It has been suggested that glycated hemoglobin (HbA1c) underestimate the actual glycemic control levels in maintenance hemodialysis (MHD) patients, because of anemia and the using of erythropoietin (EPO); it was recommended that glycated albumin (GA) should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbA1c in this research by referring to mean plasma glucose (MPG) in diabetes mellitus (DM) patients undergoing MHD or not.
  
  
  METHODS
  MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbA1c, albumin (ALB), GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbA1c was done among the groups of MHD patients with DM (n=88) and without DM (NDM; n=90), and non-MHD ones with DM (n=102) using MPG for an actual glycemic control standard.
  
  
  RESULTS
  In these 3 groups, only for DM patients' (whether undergoing MHD or not), GA and HbA1c correlated with MPG significantly (P < 0.01). Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts (2.418 vs. 2.329) and slopes (0.053 vs. 0.057) were very close to each other. On the contrary, regression curves of HbA1c did not coincide in the two groups, because variance of the slopes (0.036 vs. 0.052) were relatively large. Through comparing receiver operating characteristic (ROC) areas under the curve (AUC), it could be understood that the assessment performances of GA and HbA1c in MHD patients were lower than those in non-MHD ones, and assessment performance of HbA1c in MHD patients was better than GA (P < 0.05). In addition, the effects of Hb and EPO dose on HbA1c, or that of ALB on GA were unobvious in our study.
  
  
  CONCLUSIONS
  Actual glycemic control level in MHD patients with DM may be underestimated by HbA1c, and it could be avoided by GA; however, glycemic evaluating performance of HbA1c may be still better than that of GA. Therefore, HbA1c should not be replaced completely although GA can be used as a choice to monitor glycemic level.
authors.affiliation: Department of Nephrology, First Affiliated Hospital of People's Liberation Army General Hospital, Beijing 100048, China.
authors.forename: Feng-Kun
authors.initials: FK
authors.lastname: Chen
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Sun
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Cui
authors.forename: Xiang-Mei
authors.initials: XM
authors.lastname: Chen
authors.forename: Ri-Bao
authors.initials: RB
authors.lastname: Wei
authors.forename: Ju-Ming
authors.initials: JM
authors.lastname: Lu
authors.forename: Ji-Jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Liu
authors.forename: Dong-Liang
authors.initials: DL
authors.lastname: Zhang
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D017127:Glycation End Products, Advanced; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism*; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin