Validity of haemoglobin A1c and glycoalbumin for an appropriate evaluation of glycaemic control in Japanese diabetic patients with chronic renal failure.

Abstract

Sir, Although the validity of glycoalbumin (GA) instead of haemoglobin A1c (HbA1c) measurement in patients on haemodialysis (HD) has recently been discussed by some investigators [1,2], an appropriate indicator for glycaemic control in patients with pre-dialysis chronic renal failure (CRF) has only rarely been reported [1]. The application of erythropoietin (EPO) for the treatment of renal anaemia increases the proportion of young erythrocytes over old erythrocytes in peripheral blood [3], and HD procedure per se causes the mechanical destruction of red blood cells (RBC). These conditions may reduce the half-life of HbA1c. On the other hand, GA is affected by an accelerated turnover of albumin in the case of nephrotic syndrome frequently observed in pre-dialysis patients due to a massive loss of protein into the urine [2]. The aim of the present study is to evaluate the validity of both indicators in Japanese patients with diabetes separately according to their CRF stage, either undergoing HD or not and either being treated with EPO or not.