Glycated Albumin Versus Glycated Hemoglobin in Hemodialysis Patients with Diabetes

Abstract

SUMMARY S trict glycemic control has beneficial effects on the prognosis of patients who have diabetes with chronic kidney disease and undergo regular hemodialysis. Various parameters including fasting glucose level, postprandial glucose level, and glycated hemoglobin are used to great effect in determining the glycemic status of patients However, some reports indicate that HbA1c might not provide a relevant assay for glycemic control in HD patients. This is attributed to the decrease in the life span of erythrocytes due to the uremic environment, blood loss during treatment, frequent blood sampling, RBCs transfusions and EPO treatment. Also HbA1c represents time-averaged PG level over 3-4 months. So that concerns exist regarding the use of this marker to guide glycaemic control along with the potential risk of exposing this population to an increased risk of hyperglycaemic-related complications. Serum glycated albumin was hypothesized to be alternative marker for glycemic control in patients with diabetes as it is not affected by the changes in the survival time of erythrocytes in the case of type 2 diabetes with hemoglobinopathy. The aim of this study was to assess the utility of glycated albumin as a substitute to HbA1c quantification for the accurate assessment of glycemic control in patients with end stage renal disease. In addition, to attempt to develop an estimating equation for investigating the relationship between glycated albumin and average glucose levels. Therefore we conducted this study at the hemodialysis centre of Ain Shams University Hospital. A total of 74 subjects were included in the study. They were divided into 3 subgroups: subgroup Ia; diabetics with normal renal function