Abstract
Compared with glycated hemoglobin (HbA1c), glycated albumin (GA) is superior in estimating glycemic control in diabetic patients on hemodialysis (HD). However, the better index for assessment of glycemic control in diabetic patients on peritoneal dialysis (PD) and the impact of protein loss on GA are unknown. Twenty diabetic patients on HD were matched by age, sex, and baseline postprandial plasma glucose (PG) levels to 20 PD patients. PG, HbA1c, GA, and serum albumin levels were measured for six months. Protein loss in PD patients was estimated by measuring the protein concentration in the peritoneal dialysate and by 24 h urine collection. Although PG and HbA1c did not differ significantly between the groups, the PD group had significantly lower GA (17.8% versus 20.8%, p < 0.001) and GA/HbA1c ratio (2.95% versus 3.45%, p < 0.0001) than the HD group. Although the PG level correlated significantly with the GA levels in both groups, it was not correlated with the HbA1c levels in both groups. HbA1c level was negatively associated with erythropoiesis-stimulating agent (ESA) dose in both groups, whereas GA was not significantly associated with serum albumin, hemoglobin concentration, ESA dose, and protein loss. Multiple regression analysis identified GA as the only independent factor associated with PG in PD patients. Our results suggested that GA was not significantly associated with protein loss, hemoglobin, serum albumin, and ESA dose. Although GA might underestimate glycemic status, it provided a significantly better measure for estimating glycemic control than HbA1c, even in PD patients.
Highlights
Appropriate control of blood pressure, strict control of plasma glucose (PG) concentration, and the use of an angiotensin-converting enzyme inhibitor may prevent the development and progression of diabetic nephropathy, many patients still progress to end-stage kidney disease
HbA1c level was negatively associated with erythropoiesis-stimulating agent (ESA) dose in both groups, whereas glycated albumin (GA) was not significantly associated with serum albumin, hemoglobin concentration, ESA dose, and protein loss
Our results suggested that GA was not significantly associated with protein loss, hemoglobin, serum albumin, and ESA dose
Summary
Appropriate control of blood pressure, strict control of plasma glucose (PG) concentration, and the use of an angiotensin-converting enzyme inhibitor may prevent the development and progression of diabetic nephropathy, many patients still progress to end-stage kidney disease. Strict glycemic control has been demonstrated to have beneficial effects on the prognosis of diabetic patients with chronic kidney disease on hemodialysis (HD) [3,4,5]. For this reason, control of blood glucose levels in diabetic patients who are undergoing dialysis is important in order to reduce complications and the mortality rate. HbA1c often underestimates glycemic control of HD patients because of reduced red blood cell survival or the use erythropoiesis-stimulating agent (ESA) [6,7,8]; measurement of 1,5AG is not feasible for dialysis patients because of urine loss. The relationship between protein loss and GA in PD patients with diabetes was explored
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