title: Serum albumin-adjusted glycated albumin is a better indicator of glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis.
abstract: BACKGROUND
  Diabetic patients with end-stage renal disease who are not on haemodialysis show low concentrations of HbA1c and glycated albumin due to renal anaemia and proteinuria, respectively. In the present study, we examined whether serum albumin-adjusted glycated albumin could accurately reflect glycaemic control in these patients.
  
  
  METHODS
  To examine the correlation between glycated albumin and serum albumin (Study 1), 49 diabetic patients with end-stage renal disease not on haemodialysis were used. To evaluate the association between the glycaemic control indicators and the glycaemic control state (Study 2), 30 diabetic patients with end-stage renal disease were enrolled. The estimated HbA1c and the estimated glycated albumin concentrations were calculated based on the mean blood glucose concentrations obtained from the diurnal variation. The adjusted glycated albumin concentrations were calculated from the regression formula between the serum albumin and glycated albumin obtained from Study 1.
  
  
  RESULTS
  No significant correlation was found between the measured HbA1c and estimated HbA1c concentrations. The estimated HbA1c (inversely) and measured HbA1c/estimated HbA1c ratio (positively), but not measured HbA1c, showed a significant correlation with Hb concentrations. The estimated glycated albumin was positively associated with the measured glycated albumin and adjusted glycated albumin concentrations. Although measured glycated albumin/estimated glycated albumin ratio was positively correlated with serum albumin, there was no significant association between the adjusted glycated albumin/estimated glycated albumin ratio and serum albumin, Hb and estimated glomerular filtration rate.
  
  
  CONCLUSIONS
  We found for the first time that the adjustment of glycated albumin by serum albumin could be useful to determine glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis. These findings suggest that adjusted glycated albumin might be a better indicator of glycaemic control than measured HbA1c and measured glycated albumin in these patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Fukami
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Shibata
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Seiya
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Internal Medicine, Kawanishi City Hospital, Kawanishi, Japan m-koga@kawanishi-city-hospital.com.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Koga
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis*; D017127:Glycation End Products, Advanced; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index; D000093423:Glycated Serum Albumin
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin
keywords: Diabetic nephropathy; HbA1c; end-stage renal disease; glycated albumin; serum albumin