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Glycated Albumin Is a Better Glycemic Indicator than Glycated Hemoglobin Values in Hemodialysis Patients with Diabetes: Effect of Anemia and Erythropoietin Injection

Masaaki Inaba^*, Senji Okuno, Yasuro Kumeda^¶, Shinsuke Yamada^*, Yasuo Imanishi^*, Tsutomu Tabata, Mikio Okamura^¶, Shigeki Okada^||, Tomoyuki Yamakawa, Eiji Ishimura^*, Yoshiki Nishizawa^* and and the Osaka CKD Expert Research Group

^* Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine; Shirasagi Hospital; Inoue Hospital; ^¶ Ohno Memorial Hospital; ^|| Okada Clinic, Osaka, Japan

Address correspondence to: Dr. Masaaki Inaba, Department of Metabolism, Endocrinology and Molecular Medicine, Internal Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. Phone: +81-6-6645-3806; Fax: +81-6-6645-3808; E-mail: inaba-m{at}med.osaka-cu.ac.jp

Received for publication July 22, 2006. Accepted for publication December 14, 2006.

The significance of glycated albumin (GA), compared with casual plasma glucose (PG) and glycated hemoglobin (HbA_1c), was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. The mean PG, GA, and HbA_1c levels were 164.5 ± 55.7 mg/dl, 22.5 ± 7.5%, and 5.85 ± 1.26%, respectively, in HD patients with diabetes (n = 538), which were increased by 51.5, 31.6, and 17.7%, respectively, compared with HD patients without diabetes (n = 828). HbA_1c levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the relationship among the three parameters in patients who had diabetes without renal dysfunction (n = 365), as reflected by the significantly more shallow slope of regression line between HbA_1c and PG or GA. A significant negative correlation was found between GA and serum albumin (r = –0.131, P = 0.002) in HD patients with diabetes, whereas HbA_1c correlated positively and negatively with hemoglobin (r = 0.090, P = 0.036) and weekly dose of erythropoietin injection (r = –0.159, P < 0.001), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA_1c levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartile by HbA_1c level led to better glycemic control in a significantly higher proportions of HD patients with diabetes than those assessed by GA. Multiple regression analysis demonstrated that the weekly dose of erythropoietin, in addition to PG, emerged as an independent factor associated with HbA_1c in HD patients with diabetes, although PG but not albumin was an independent factor associated with GA. In summary, it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA_1c in these patients might lead to underestimation likely as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.

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