Glycated hemoglobin and glycated albumin in patients with diabetes undergoing hemodiafiltration

Abstract

Background: Online hemodiafiltration (OHDF), which results in high albumin leakage, is now widely used in Japan for dialysis, since the national insurance system began reimbursing its costs in 2012. Glycated albumin (GA) levels are affected by albumin leakage into effluent dialysate fluid. Therefore, GA levels in patients requiring diabetesrelated dialysis undergoing OHDF require monitoring. However, there have been no previous reports on glycemic control indicators of patients with diabetes undergoing OHDF. We aimed to develop a glycemic control index for patients requiring diabetes-related dialysis undergoing OHDF. Methods: This study comprised 133 diabetic patients undergoing OHDF. We examined the correlation between GA and glycated hemoglobin (HbA1c) levels. We analyzed effluent dialysate fluid samples from 41 patients classified into 3 groups, namely, group A, non-protein-leaking OHDF (n = 20); group B, protein-leaking OHDF (n = 14); and group C, highly efficient protein-leaking OHDF (n = 7). We examined the association between GA and HbA1c levels in each group and among patients. Results: A significant positive correlation was observed between GA and HbA1c levels (r = 0.562, p < 0.0001). There was no significant correlation between pre-dialysis blood glucose levels and HbA1c or GA levels as observed on regular blood tests performed under non-fasting conditions. Patients were classified into 2 groups based on their mean albumin levels (3.4 g/dL cutoff). The correlation between HbA1c and GA levels was found to be weaker in the 51 patients with mean albumin levels < 3.4 g/dL (r = 0.399, p = 0.0037) than in the 82 patients with mean albumin levels ≥ 3.4 g/dL (r = 0.674, p < 0.0001). When the hemodiafilter performance was assessed, no correlation was observed between HbA1c and GA levels in group C patients. Conclusions: GA levels may be underestimated in patients undergoing OHDF because of the effect of albumin leakage into the effluent dialysate fluid. If a stable hemoglobin value can be maintained during OHDF therapy, then GA and HbA1c levels should be used as a glycemic control index for patients requiring diabetes-related dialysis, considering the dialysis treatment method and protein permeability of the dialyzers and hemodiafilters.

Advanced glycation end-products associate with podocytopathy in type II diabetic patients

“…Diabetes mellitus (type II) has long been a growing epidemic. Asia accounts for 60% of the world's diabetic population 1,2 . The increased prevalence of diabetes led to a surge in the incidence of macro-and microvascular complications such as visual impairment, coronary heart disease, stroke, neuropathy, and diabetic nephropathy (DN).…”

“…Among the myriad of hemodynamic, metabolic, and in ammatory factors that participate in DN's pathogenesis, persistent hyperglycemia is predominant. It is noteworthy that a strong relationship between poor glycemic control and DN exists 6,7 . Prolonged hyperglycemia ensures the formation of advanced glycation end-products (AGEs) in the kidney and other sites of diabetic complications 8 .…”

“…It is noteworthy that a strong relationship between poor glycemic control and DN exists 6,7 . Prolonged hyperglycemia ensures the formation of advanced glycation end-products (AGEs) in the kidney and other sites of diabetic complications 8 . AGEs comprise heterogeneous compounds formed during a series of non-enzymatic (Maillard) glycation (NEG) reactions between the amino group of proteins, lipids, and nucleotides with reducing sugars [9][10][11] .…”

“…It is debated whether HbA1c corresponds to the same mean glucose concentrations in people with ESKD 18,19 . Further, HbA1c is in uenced by several factors, including the RBCs' lifespan, administration of erythropoietin, uremic environment, and blood transfusions 17,20,21 . In contrast, glycated albumin (GA) is suggested as a preferred marker for assessing glycemic control in advanced chronic kidney disease only 17 .…”

“…Further, HbA1c is in uenced by several factors, including the RBCs' lifespan, administration of erythropoietin, uremic environment, and blood transfusions 17,20,21 . In contrast, glycated albumin (GA) is suggested as a preferred marker for assessing glycemic control in advanced chronic kidney disease only 17 . According to UK prospective diabetes study (UKPDS), intensive blood-glucose control in patients with type II diabetes reduces microvascular complications, particularly in patients with a diabetic kidney disease whose cardiovascular risk increases with worsening proteinuria 20,22 .…”