Glycated Albumin Predicts the Risk of Mortality in Type 2 Diabetic Patients on Hemodialysis: Evaluation of a Target Level for Improving Survival

Abstract

Glycated albumin (GA) is considered a more reliable marker than glycated hemoglobin (HbA1c) for monitoring glycemic control, particularly in diabetic hemodialysis patients. We investigated the associations of GA, HbA1c, and random serum glucose levels with survival, and evaluated possible targets for improving survival in diabetic hemodialysis patients. In this prospective, longitudinal, observational study, we enrolled 90 diabetic hemodialysis patients across six dialysis centers in Japan. The median duration of follow-up was 36.0 months (mean follow-up, 29.8 months; range, 3-36 months). There were 11 deaths during the observation period. GA was a significant predictor for mortality (hazard ratio, 1.143 per 1% increase in GA; 95% confidence interval, 1.011-1.292; P = 0.033), whereas HbA1c and random glucose levels were not predictors for mortality. Receiver operating characteristics curve analysis showed that the cutoff value of GA for predicting the risk of mortality was 25%. In the Kaplan-Meier analysis, the cumulative survival rate was significantly greater in patients with GA ≤ 25% than in patients with GA >25%. GA predicted the risk of all-cause and cardiovascular mortality in diabetic hemodialysis patients. Our results suggest that GA ≤ 25% is an appropriate target for improving survival in diabetic hemodialysis patients.

Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D)

“…The authors concluded that hyperglycemia may have a small direct influence on survival and that, as previously reported [61,62], mortality in ESRD is mainly driven by advanced atherosclerosis and other cardiovascular risk factors. In fact, as described in more detail in the next section, GA levels were associated with CVD but not with any increase in CVD mortality, as observed in other studies [18,45,[63][64][65][66].…”

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

“…Our data showed that GA levels were a better indicator of the glucose fluctuations. A few recent studies have reported finding that high GA levels were associated with increased mortality in diabetic HD patients [19,20].…”

Haemodialysis-induced hypoglycaemia and glycaemic disarrays

“…Levels of glycated albumin might, therefore, be a better indicator of glycaemic control than levels of HbA1c in these patients. Several studies have shown positive associations between levels of glycated albumin and all-cause or cardiovascular mortality in diabetic patients on haemodialysis 130–135. Notably, no significant associations between average HbA1c levels and mortality were reported.…”