Abstract
BackgroundThe association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes. We investigated the usefulness of GA by comparing it with hemoglobin A1c (HbA1c) in this patient population.Research design and methodsThis was a multi-center, prospective cohort study of 841 Japanese chronic hemodialysis patients with diabetes. There were 235 women and 606 men included, with a mean age of 64 years. The primary and secondary endpoints were the incidence of all-cause and cause-specific mortality, respectively. The hazard ratios of GA and HbA1c for the endpoints were estimated using the values at baseline and during the study period.ResultsDuring the mean follow-up period of 3.1 years, there were 184 deceased cases, in which 30 and 154 resulted from atherosclerotic cardiovascular disease (ASCVD) and non-ASCVD, respectively. The hazard ratio for a 1% increase in GA was 1.033 (95% confidence interval 1.006–1.060, p = 0.017) for all-cause mortality with a statistical significance when GA was treated as a time dependent variable, but not when the baseline levels or the mean levels during the follow-up period were used in the analysis (p = 0.815 and 0.517, respectively). GA was a significant predictor for ASCVD-related mortality in the above 3 models, but was not for non-ASCVD mortality. Higher levels of HbA1c were only associated with ASCVD-related mortality when HbA1c was treated as a time-dependent variable.ConclusionsGA may be useful compared to HbA1c for predicting all-cause and ASCVD-related mortality in Japanese patients with diabetes undergoing chronic hemodialysis.
Highlights
The association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes
The hazard ratio for a 1% increase in GA was 1.033 (95% confidence interval 1.006–1.060, p = 0.017) for all-cause mortality with a statistical significance when GA was treated as a time dependent variable, but not when the baseline levels or the mean levels during the followup period were used in the analysis (p = 0.815 and 0.517, respectively)
GA may be useful compared to hemoglobin A1c (HbA1c) for predicting all-cause and atherosclerotic cardiovascular disease (ASCVD)-related mortality in Japanese patients with diabetes undergoing chronic hemodialysis
Summary
The association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes. Previous cohort studies have reported that higher levels of hemoglobin A1c (HbA1c), the gold standard indicators of glycemic control, predicted all-cause and cardiovascular mortality in patients with diabetes undergoing chronic hemodialysis [2,3,4]. Few large cohort studies have reported an association between GA and mortality in such patient population [8, 9]; these studies were retrospectively designed and did not evaluate GA values during the study period, these levels can vary over time. We prospectively investigated the usefulness of GA, assessed based on both baseline and follow-up values, with respect to mortality by comparing it with HbA1c in Japanese chronic hemodialysis patients with diabetes
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