Abstract
Background
Since the half-life of red blood cells (RBCs) is shorter in hemodialysis patients, the value of glycated hemoglobin (HbA1c) as a marker of glycemic control in patients with diabetes on hemodialysis has recently been questioned. It is thought that it is not a good marker of mean plasma glucose (MPG) over a 3-month duration. In our current study, we evaluate whether monthly HbA1c values is a better marker of glycemic control than HbA1c every 3 months.
Method
We performed a cross-sectional analysis of a retrospective cohort of 152 patients with diabetes who presented to two hemodialysis units in NYC. Patients had weekly predialysis glucose levels checked over the last 3 months, and HbA1c values were checked every 3 months. Data collection spanned a 6-month time frame from August 2008 to January 2009.
Results
We found no difference in the correlation between HBA1c/mean plasma glucose (MPG) over the last month (MPG1m) and HbA1c/mean plasma glucose (MPG) over the last 3 months (MPG3m; r = 0.57 and r = 0.53, respectively; P = 0.212). Using multivariate analysis, reticulocyte count and weekly erythropoietin dose were found to independently and inversely effect the correlations HbA1c/MPG1m and HbA1c/MPG3m.
Conclusion
The value of HbA1c in hemodialysis for monitoring glycemic control is limited in the setting of a high reticulocyte count (>2%) and a high weekly erythropoietin dose. Checking HbA1c monthly versus every 3 months is not a better approximation of glycemic control in hemodialysis patients.
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References
Foley RN, Collins AJ (2009) The growing economic burden of diabetic kidney disease. Curr Diab Rep 9:460–465
Warram JH, Manson JE, Krolewski AS (1995) Glycosylated hemoglobin and the risk of retinopathy in insulin-dependent diabetes mellitus. N Engl J Med 332:1305–1306
Townsend RR (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 329:977–986
Hirszel P, Galen MA, Happe T, Lasrich M (1981) Glycosylated hemoglobin in patients treated by chronic dialysis. Int Urol Nephrol 13:185–191
Freedman D, Dandona P, Fernando O, Moorhead JF (1982) Glycosylated haemoglobin in chronic renal failure and after renal transplantation. J Clin Pathol 35:737–739
Williams ME, Lacson E Jr, Teng M, Ofsthun N, Lazarus JM (2006) Hemodialyzed type I and type II diabetic patients in the US: characteristics, glycemic control, and survival. Kidney Int 70:1503–1509
Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, Okamura M, Okada S, Yamakawa T, Ishimura E, Nishizawa Y (2007) Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol 18:896–903
Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE (2002) Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the diabetes control and complications trial. Diabetes Care 25:275–278
Uzu T, Hatta T, Deji N, Izumiya T, Ueda H, Miyazawa I, Kanasaki M, Isshiki K, Nishio T, Arimura T (2009) Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A(1c). Ther Apher Dial 13:89–94
Drechsler C, Krane V, Ritz E, Marz W, Wanner C (2009) Glycemic control and cardiovascular events in diabetic hemodialysis patients. Circulation 120:2421–2428
Masanori S, Toshihiko S, Koji H, Hidekazu H, Mitsuharu H, Takanobu A, Takeshi I, Yasuyuki B, Shigefumi S (2004) Orally administered benidipine and manidipine prevent ischemia-reperfusion injury in the rat heart. Circ J 68:241–246
Peacock TP, Shihabi ZK, Bleyer AJ, Dolbare EL, Byers JR, Knovich MA, Calles-Escandon J, Russell GB, Freedman BI (2008) Comparison of glycated albumin and hemoglobin A(1c) levels in diabetic subjects on hemodialysis. Kidney Int 73:1062–1068
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Israel, E., Geara, A., Maarouf, O. et al. Correlation between glycated hemoglobin and mean plasma glucose in hemodialysis patients. Int Urol Nephrol 43, 1149–1153 (2011). https://doi.org/10.1007/s11255-010-9800-1
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DOI: https://doi.org/10.1007/s11255-010-9800-1