Performance of non‐traditional hyperglycemia biomarkers by chronic kidney disease status in older adults with diabetes: Results from the Atherosclerosis Risk in Communities Study: 在老年糖尿病患者慢性肾脏疾病状态下非传统高血糖生物标志物的检测效能:来自评估动脉粥样硬化风险社区研究的结果
Open accessAbstract
Background: In people with chronic kidney disease (CKD), HbA1c may be a problematic measure of glycemic control. Glycated albumin and fructosamine have been proposed as better markers of hyperglycemia in CKD. In the present study we investigated associations of HbA1c, glycated albumin, and fructosamine with fasting glucose by CKD categories. Methods: A cross‐sectional analysis was performed of 1665 Atherosclerosis Risk in Communities Study participants with diagnosed diabetes aged ≥65 years. Spearman's rank correlations ( r ) were compared and Deming regression was used to obtain root mean square errors (RMSEs) for the associations across CKD categories defined using estimated glomerular filtration rate and urine albumin:creatinine ratio. Results: Correlations of HbA1c, glycated albumin, and fructosamine with fasting glucose were lowest in people with severe CKD (HbA1c r = 0.52, RMSE = 0.91; glycated albumin r = 0.39, RMSE = 1.89; fructosamine r = 0.41, RMSE = 1.87) and very severe CKD ( r = 0.48 and RMSE = 1.01 for HbA1c; r = 0.36 and RMSE = 2.14 for glycated albumin; r = 0.36 and RMSE = 2.22 for fructosamine). Associations of glycated albumin and fructosamine with HbA1c were relatively similar across CKD categories. Conclusions: In older adults with severe or very severe CKD, HbA1c, glycated albumin, and fructosamine were not highly correlated with fasting glucose. The results suggest there may be no particular advantage of glycated albumin or fructosamine over HbA1c for monitoring glycemic control in CKD.
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Compared with actual blood glucose, the glycated albumin assay is biased by hypoalbuminemia, a common condition in patients with CKD due to protein losses in the urine, malnutrition, or peritoneal dialysis.
“However, compared with actual blood glucose, the glycated albumin assay is biased by hypoalbuminemia, a common condition in patients with CKD due to protein losses in the urine, malnutrition, or peritoneal dialysis.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [197]
The Discussion (page not available) says glycated albumin values can be altered independently of average glucose in CKD because of proteinuria and impaired protein homeostasis. The Methods (page not available) also note that abnormal albumin metabolism may affect its values and exclude people with low serum albumin. The paper does not establish that hypoalbuminemia biases the assay relative to actual blood glucose, or identify malnutrition and peritoneal dialysis as causes of that bias. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAccuracy 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 [197]
The Results (page unavailable) report a weaker association between HbA1c and fasting glucose in very severe CKD than in people without CKD. The Discussion (page unavailable) says HbA1c is particularly problematic to interpret in dialysis patients. However, the paper does not establish that the analytical accuracy or precision of HbA1c measurement declines across G4–G5, or quantify measurement reliability in dialysis patients. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCorrelations 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 [197]
The Results report weaker correlations of all three biomarkers with fasting glucose in more severe CKD categories. However, the Methods define the paper’s “very severe CKD” group more broadly than G4–G5, and the Discussion attributes the dialysis comparison to previous studies of HbA1c and glycated albumin, not to this study’s findings for all three biomarkers. The claim’s emphasis on dialysis-treated kidney failure is therefore not supported by this paper’s results. (LLM, conf=0.88)
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Cuevas‐Budhart, M. Á., Gómez-Rosas, K., Saavedra-Fernández, R. D., Ávila, M., Campos, E. I., Ferreira‐Hermosillo, A., Ramos, A., Cavero‐Redondo, I., & Paniagua, R. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15166137
- Authors
- Jung, M., Warren, B., Grams, M., Kwong, Y. D., Shafi, T., Coresh, J., Rebholz, C. M., & Selvin, E.
- Affiliations
- Johns Hopkins University (US)
- University of California, San Francisco (US)
- Corresponding author
- Selvin, Elizabeth
- ORCID
- Venue
- Journal of Diabetes
- Publisher
- Wiley
- Published
- 2017-12-21
- Volume
- 10
- Issue
- 4
- Pages
- 276-285
- ISSN
- 1753-0393 (ISSN-L)
- 1753-0407
- PMC
- PMC5867205
- OpenAlex
- W2765190241
- Cited by
- 43
- References
- 40
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 13 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (T32 HL007024)
- National Institute of Diabetes and Digestive and Kidney Diseases (R03DK104012, R01DK089174, K24DK106414, K01DK107782)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- 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
- chronic kidney disease, glycemic control, HbA1c, glycated albumin, fructosamine, fasting blood glucose, diabetes mellitus, older adults, estimated glomerular filtration rate, urine albumin-creatinine ratio, glycemic markers, Atherosclerosis Risk in Communities Study
- MeSH terms
- Glycated Serum Albumin, Aged, Aged, 80 and over, Blood Glucose, Community Health Services, Cross-Sectional Studies, Diabetes Mellitus, Fasting, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Risk Factors, Serum Albumin, Biomarkers, Glycation End Products, Advanced, Fructosamine, Atherosclerosis, Renal Insufficiency, Chronic
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