Influence of proteinuria on glycated albumin values in diabetic patients with chronic kidney disease
Open accessAbstract
BACKGROUND: Glycated albumin (GA), which is an alternative glycemic marker, is influenced by factors associated with albumin turnover, and it is not clear whether proteinuria influences GA values in diabetic patients with chronic kidney disease (CKD). METHODS: We enrolled 94 diabetic patients with CKD stages 3 to 5. GA, glycated hemoglobin, and urinary protein excretion (UP) levels were consecutively obtained in each patient. The correlations between GA and UP and those between changes in GA and UP were examined. RESULTS: There was a significant correlation between GA and UP in all cases (r=-0.46, p<0.0001), however no significant correlation was found in cases with UP of 0-3.49 g/day (r=0.01). GA values in cases with UP ≥3.5 g/day were significantly lower than those in cases with UP <3.5 g/day [UP ≥3.5 g/day and serum albumin (Alb) ≤3 g/dL; 12.0 ± 1.3%, UP ≥3.5 g/day and Alb >3 g/dL; 17.8 ± 4.3%, 0≥ UP <3.5 g/day; 21.2 ± 4.2%], while no significant difference in HbA(1c) or glucose levels was found. In cases with a minimum of UP ≥0.5 g/day, no significant correlation was found between the difference in GA and the difference in UP at the point of maximum UP and minimum UP (r=0.04). CONCLUSION: Nephrotic-range proteinuria decreases GA values independent of the glycemic state, while non-nephrotic range proteinuria has no significant influence on GA values in diabetic CKD patients.
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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 [210]
The ‘Correlations among GA, UP and other clinical variables at baseline’ section (page unavailable) reports associations of measured glucose with glycated albumin and HbA1c. It does not report progressively weaker correlations across CKD stages G4–G5, a fructosamine analysis, or correlations in patients treated by dialysis. Its Groups 4 and 5 are defined by proteinuria and serum albumin, not CKD stage. (LLM, conf=0.86)
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 [210]
The Introduction says erythrocyte turnover and ESA treatment can lower HbA1c independently of glycemic control, and that glycated albumin has been shown to be more accurate in diabetic dialysis patients. The Discussion does not establish declining HbA1c accuracy or precision specifically across CKD stages G4–G5; it says this study found HbA1c associated with glucose and calls for further study of factors affecting HbA1c. (LLM, conf=0.85)
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- Authors
- Okada, T., Nakao, T., Matsumoto, H., Nagaoka, Y., Tomaru, R., Iwasawa, H., & Wada, T.
- Affiliations
- Tokyo Medical University (JP)
- ORCID
- Matsumoto, Hiroshi
- Venue
- Internal Medicine
- Published
- 2011
- Volume
- 50
- Issue
- 1
- Pages
- 23-29
- ISSN
- 0918-2918 (ISSN-L)
- 1349-7235
- OpenAlex
- W1984367359
- Cited by
- 81
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 4 · 2022: 14 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 2 · 2015: 11 · 2014: 9 · 2013: 4 · 2012: 5
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- glycated albumin, proteinuria, chronic kidney disease, diabetes mellitus, nephrotic-range proteinuria, albumin turnover, glycemic markers, HbA1c, urinary protein excretion
- MeSH terms
- Glycated Serum Albumin, Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Female, Glycated Hemoglobin, Humans, Kidney Failure, Chronic, Male, Middle Aged, Nephrotic Syndrome, Proteinuria, Serum Albumin, Biomarkers, Glycation End Products, Advanced, Renal Insufficiency, Chronic
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