Comparison of glycated albumin and hemoglobin A1c levels in diabetic subjects on hemodialysis
Open accessAbstract
Glycated albumin is thought to more accurately reflect glycemic control in diabetic hemodialysis patients than hemoglobin A(1c) because of shortened red cell survival. To test this, glycated hemoglobin and albumin levels were measured in blood samples collected from 307 diabetic subjects of whom 258 were on hemodialysis and 49 were without overt renal disease. In diabetic subjects with renal disease, relative to those without, the mean serum glucose and glycated albumin concentrations were significantly higher while hemoglobin A(1c) tended to be lower. The glycated albumin to hemoglobin A(1c) ratio was significantly increased in dialysis patients compared with the controls. Hemoglobin A(1c) was positively associated with hemoglobin and negatively associated with the erythropoietin dose in hemodialysis patients, whereas these factors and serum albumin did not significantly impact glycated albumin levels. Using best-fit multivariate models, dialysis status significantly impacted hemoglobin A(1c) levels without a significant effect on glycated albumin. Our results show that in diabetic hemodialysis patients, hemoglobin A(1c) levels significantly underestimate glycemic control while those of glycated albumin more accurately reflect this control.
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Accuracy and precision of HbA1c measurement declines with advanced CKD (G4-G5), particularly among patients treated by dialysis, in whom HbA1c measurements have low reliability.
“Practice Point 2.1.2: Accuracy and precision of HbA1c measurement declines with advanced CKD (G4 -G5), particularly among patients treated by dialysis, in whom HbA1c measurements have low reliability.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [227]
Correlations of directly measured blood glucose levels with HbA1c, glycated albumin, and fructosamine were progressively weaker with advanced CKD stages (G4-G5), especially kidney failure treated by dialysis.
“Correlations of directly measured blood glucose levels with 3 glycemic biomarkers -HbA1c, glycated albumin, and fructosamine -were progressively weaker with advanced CKD stages (G4 -G5), especially kidney failure treated by dialysis. 196,197,205,210,227”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [227]
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- Authors
- Peacock, T. P., Shihabi, Z. K., Bleyer, A. J., Dolbare, E. L., Byers, J. R., Knovich, M. A., Calles-Escandon, J., Russell, G. B., & Freedman, B. I.
- Affiliations
- Wake Forest University Health Sciences (US)
- Corresponding author
- Freedman, B.I.
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 73
- Issue
- 9
- Pages
- 1062-1068
- ISSN
- 0085-2538 (ISSN-L)
- OpenAlex
- W2040722615
- Cited by
- 323
- References
- 22
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 6 · 2023: 6 · 2022: 18 · 2021: 11 · 2020: 15 · 2019: 14 · 2018: 19 · 2017: 17 · 2016: 20 · 2015: 26 · 2014: 27 · 2013: 33 · 2012: 24
- FWCI
- 19.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Keywords
- glycated albumin, HbA1c, glycemic control, diabetes mellitus, hemodialysis, erythropoietin, hemoglobin, serum albumin, kidney disease
- MeSH terms
- Glycated Serum Albumin, Diabetes Mellitus, Female, Renal Dialysis, Glycated Hemoglobin, Humans, Male, Middle Aged, Serum Albumin, Glycation End Products, Advanced
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