Abstract
BackgroundTo assess whether the agreement between fasting glucose and glycated proteins is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-ancestry South Africans.MethodsCKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2. Fasting plasma glucose and haemoglobin A1c (HbA1c) concentrations were measured by enzymatic hexokinase method and high-performance liquid chromatography, respectively, with fructosamine and glycated albumin measured by immunoturbidimetry and enzymatic method, respectively.ResultsOf those with CKD (n = 96), 79, 16 and 5% where in stages 3, 4 and 5, respectively. Those with CKD had higher levels of HbA1c (6.2 vs. 5.7%; p < 0.0001), glycated albumin (15.0 vs. 13.0%; p < 0.0001) and fructosamine levels (269.7 vs. 236.4 μmol/l; p < 0.0001), compared to those without CKD. Higher fasting glucose levels were associated with higher HbA1c, glycated albumin and fructosamine, independent of age, gender, and CKD. However, the association with HbA1c and glycated albumin differed by CKD status, at the upper concentrations of the respective markers (interaction term for both: p ≤ 0.095).ConclusionOur results suggest that although HbA1c and glycated albumin perform acceptably under conditions of normoglycaemia, these markers correlate less well with blood glucose levels in people with CKD who are not on dialysis.
Highlights
To assess whether the agreement between fasting glucose and glycated proteins is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-ancestry South Africans
Participants with CKD had higher levels of haemoglobin A1c (HbA1c) (6.2 vs. 5.7%; p < 0.0001); increasing incrementally for each glycaemic group, namely normoglycaemia [median (25th–75th percentile): 6.0 (5.7–6.2)], Impaired fasting glucose (IFG)/ Impaired glucose tolerance (IGT) [median (25th–75th percentile): 6.2 (5.9–7.1)] and type 2 diabetes (T2D) [median (25th–75th percentile): 7.3 (6.3–8.9)]
This study found that Fasting plasma glucose (FPG) correlated most closely with HbA1c, compared to the alternative markers of chronic glycaemia, the association between FPG and HbA1c as well as with glycated albumin (GA) differed by CKD status, at the higher concentration of these markers
Summary
To assess whether the agreement between fasting glucose and glycated proteins is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-ancestry South Africans. Chronic kidney disease (CKD) is estimated to affect about 10% of the general adult population and is even more prevalent in diabetic patients [1, 2]. Sequential measurements of blood glucose and/or haemoglobin A1c (HbA1c) (reflecting glycaemic control of the preceding 2–3 months) have been used to monitor glycaemia in patients with diabetes [6]. Decreased erythropoiesis leads to increased circulating aged red blood cells (RBCs) and a progressive rise in HbA1c, unrelated to glycaemic control [7, 9]. There are several other diseases, prevalent in Africa, that affect the clinical utility of HbA1c and for which alternative markers may be necessary, including sickle-cell disease in the more endemic malaria prone regions, as well as HIV/AIDS and tuberculosis [11, 12]
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